Abstract
Primary biliary cholangitis and sarcoidosis are the two most common causes of granulomatous liver disease in the US; however, their expected clinical course and management are starkly different. This case involves a patient with granulomas noted on liver biopsy, presumed secondary to known sarcoidosis, later found to have concurrent primary biliary cholangitis. Prompt diagnosis of primary biliary cholangitis is crucial as its natural course of progressive liver fibrosis can be significantly improved with treatment.