Sarcoidosis is believed to be rare in Saudi Arabia. We report twenty cases of sarcoidosis among native Saudis followed-up at our tertiary care centre. The majority (55%) of these patients were referred as either tuberculosis or lymphoma. Twelve out of twenty patients had been or were being treated for pulmonary tuberculosis at the time of presentation. The clinical presentation of these patients was similar to the western pattern of disease with some differences such as severe constitutional symptoms (52%), relative frequent eye involvement (35%) and common occurrence of stage II changes on chest film (70%). Mantoux skin test was negative in nineteen patients (95%). Histological evidence of non-caseating granulomata was obtained in 19 patients. A positive correlation (p < 0.034) between constitutional symptoms and Angiotensin Converting Enzyme (ACE) levels was noted. Thirteen patients (65%) were treated with oral steroids while topical ophthalmic steroids were used in seven patients (35%). Functional and radiographic deterioration was observed in four patients (20%). Three patients went into respiratory failure including a patient who developed Hodgkin's lymphoma six years after the diagnosis of sarcoidosis. The epidemiology of sarcoidosis among native Saudis requires further studies.