A Rare Case of Necrotising Sarcoid Granulomatosis Presenting as Bilateral Pulmonary Masses Mimicking Malignancy

Necrotising sarcoid granulomatosis (NSG) is a rare granulomatous lung disease characterised by non-caseating granulomas, necrosis, and vasculitis. We describe a 50-year-old man who presented with constitutional symptoms and bilateral pulmonary masses initially suggestive of metastatic malignancy. Extensive infectious, malignant, and autoimmune workup was negative. Histopathology from lung biopsies and a video-assisted thoracoscopic surgery (VATS) resection revealed granulomatous inflammation with necrosis and no evidence of malignancy or infection. A trial of corticosteroids resulted in clinical, biochemical, and radiological improvement. This case highlights the diagnostic challenges of NSG and the importance of multidisciplinary evaluation to avoid misdiagnosis.