结节病是一种表现多样的多系统炎症性疾病。结节病最典型的特征是非坏死性肉芽肿。然而，当结节病出现罕见的器官受累且活检显示坏死时，诊断就变得具有挑战性。在此，我们介绍三例结节病，器官受累异常且活检发现坏死，导致诊断和治疗的延误。病例 1 表现为腮腺内淋巴结和泌尿生殖区淋巴网状受累。附睾活检显示坏死，最初导致结核病 (TB) 的治疗。病例 2 描述了淋巴网状受累和心脏症状。他的宫颈和骨髓活检显示坏死。病例 3 的表现是播散性淋巴结病并伴有肝脾肿大，最初怀疑为恶性肿瘤或结核病。虽然活检在诊断结节病中发挥着重要作用，但仅凭坏死的存在不应导致其被排除。© 印度医师协会杂志 2024 年。

Sarcoidosis is a multisystem inflammatory disease with a variable presentation. The most characteristic feature of sarcoidosis is nonnecrotizing granulomas. However, when sarcoidosis presents with rare organ involvement, and biopsy shows necrosis, the diagnosis becomes challenging.Here, we present three cases of sarcoidosis with unusual organ involvement and biopsy findings of necrosis, leading to a delay in diagnosis and treatment. Case 1 was presented with lymphoreticular involvement within the intraparotid lymph node and genitourinary area. Biopsy from the epididymis showed necrosis, initially leading to treatment for tuberculosis (TB). Case 2 describes lymphoreticular involvement and cardiac symptoms. His cervical and bone marrow biopsies showed necrosis. Case 3's presentation was disseminated lymphadenopathy with hepatosplenomegaly, initially suspected as malignancy or TB.While biopsy plays a significant role in diagnosing sarcoidosis, the presence of necrosis alone should not lead to its exclusion.© Journal of the Association of Physicians of India 2024.