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The financial support of W. J. W. by the Agricultural Research Council is gratefully acknowledged (grant no. AG35/44).

INTRODUCTION: Anti-tumor necrosis factor (anti-TNF) therapy for refractory sarcoidosis has been the subject of ongoing investigation, given the active role TNF-a plays in both initiation and the chronic stages of the disease. While sarcoid-like reaction associated with anti-TNF therapy was previously described, we report a novel case of this reaction in a patient on long-term anti-TNF therapy shortly after initiation of anti-immunoglobulin E (anti-IgE) therapy. Reference #1: Daien et al. Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases.