Upper respiratory tract involvement occurs in 1 to 6% of all patients with sarcoidosis. Dry cough, hoarseness, dyspnea and dysphagia are the main symptoms. The diagnosis is established by biopsy demonstrating granulomatous lesions. We report the case of a 22-year-old woman who presented with erythema nodosum, arthralgias and granulomatous lesions of the trachea, larynx and bronchi. Although the biopsies of the lesions were nondiagnostic, the diagnosis of acute sarcoidosis was made, and a steroid therapy was initiated. The patient recovered rapidly, and the lesions disappeared. The features and differential diagnosis of upper respiratory tract sarcoidosis are discussed.