Introduction: Sarcoidosis is a multisystem granulomatous disease that remains diagnostically challenging due to its heterogeneous clinical presentation and overlap with infectious, malignant, and autoimmune disorders. Endoluminal stenosis of the proximal bronchi  represents a severe manifestation of the disease. Its atypical clinical presentation, coupled with the variability in therapeutic response, underscores the need for meticulous diagnostic evaluation and rigorous follow‑up.

Clinical Case Description: We present the case of a 43-year-old man with a history of cutaneous sarcoidosis, referred for evaluation of cervical lymphadenopathy and equivocal flow cytometry. Histopathological analysis of an excised cervical lymph node revealed non-necrotizing sarcoid-type granulomatous adenitis, with negative flow cytometry. Initial systemic screening tests, including cardiac, ophthalmologic, and pulmonary evaluations, showed nothing remarkable. The patient was treated with corticosteroids and methotrexate for one year, followed by maintenance therapy with methotrexate. Despite partial regression of mediastinal adenomegaly on PET imaging, he developed recurrent pneumonia, and fibrobronchoscopy revealed severe endobronchial stenosis, the mucosa of the intermediate bronchus exhibited a cobblestone‑like appearance, there was marked reduction of the lumen of the left main bronchus, preventing passage of the endoscope. the stenosis persisted after dilation, with no evidence of extrinsic compression. after dilation and without evidence of extrinsic compression The.biopsy rule out malignant and infectious etiologies. He is currently continuing treatment with methotrexate at a dose of 25 mg weekly and is awaiting initiation of treatment with infliximab.

Conclusions: The incidence and prevalence of endobronchial sarcoidosis is unknown, it is recognized as a sentinel finding in advanced disease. This case underscores the importance of timely recognition and aggressive management of Endobronchail sarcoidosis to improve long‑term outcomes. The persistence of stenosis after dilation underscores the fibrotic nature of airway involvement. Escalation to biologic therapy with infliximab is warranted in refractory cases and may provide improved disease control.