Acute sarcoidosis in an octogenarian is rare. In this case bone-mnarrow trephine biopsy uncovered an unsuspected diagnosis. Case report An 81-year-old spinster presented with a six-month history of anorexia, weight loss of 6-35 kg, and lower abdominal distension which was always relieved by an episode of diarrhoea. The only other symptoms were night sweats and nocturnal leg cramps, both of which had lasted for one month. Her history included Bell's palsy at the age of 70, a severe epistaxis

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... iring hospital admission when she was 79, and longstanding congestive cardiac failure, which had been controlled by digoxin and diuretics. These were her only medications. On examination she had no fever, there were palpable mobile lymph registrar in respiratory medicine, Royal Brisbane Hospital, Brisbane, T J HAMBLIN, MRCP, MRCPATH, consultant haematologist J R MIKHAIL, MRcs, LRCP, consultant chest physician