Pulmonary sarcoidosis in a young patient is usually a relatively benign disease that either resolves spontaneously or remains quiescent for many years. Very rarely it pursues a more aggressive course leading to progressive lung destruction. We report a young patient who presented with Stage III sarcoidosis and over a period of 4 yr progressed to severe cavitary disease with frequent superinfections leading to bronchiectasis and chronic suppuration of the lung, eventually requiring a pneumonectomy.