A rare cause of hematuria; a case report of sarcoidosis

Background Sarcoidosis is a chronic multisystem granulomatous disease most frequently involving the lungs and hilar lymph nodes. Genitourinary involvement, especially bladder sarcoidosis, is extremely rare. Case Presentation: We report a 52-year-old female with a history of pulmonary sarcoidosis who later developed hematuria. Initial thoracic imaging and CP-EBUS revealed non-caseating granulomatous inflammation, consistent with sarcoidosis. After six years of follow-up, the patient developed urinary symptoms. Cystoscopy revealed raised bladder lesions, and biopsy confirmed chronic non-caseating granulomatous inflammation. The patient was treated with corticosteroids and later azathioprine was added due to persistent disease activity. Conclusion Bladder involvement in sarcoidosis is rare and often difficult to diagnose due to nonspecific findings. Careful monitoring of sarcoidosis patients, including assessment for urinary symptoms, is essential for early detection and timely management.