We present a case of hepatosplenic necrotizing sarcoid granulomatosis, a variant form of "classical" sarcoidosis, that became clinically apparent in the form of multiple hepatic and splenic masses mimicking malignancy. Flow cytometry of intrahepatic T cells isolated from liver biopsy led to the targeted treatment with anti-tumor necrosis factor-alpha, which was highly effective in inducing remission. (Hepatology 2017;65:1410-1412).