We present a case of a patient with pulmonary sarcoidosis who developed ulcerative sarcoidosis with granulomatous vasculitis on the lower legs. Ulceration is a rare presentation for sarcoidosis and this case gives further evidence that an underlying vasculitis may be an aetiological factor. Granulomatous vasculitis, classically associated with Wegener's granulomatosis, lymphomatoid granulomatosis, or Churg-Strauss syndrome, is also commonly described in pulmonary sarcoidosis. It has, however, only rarely been described in cutaneous sarcoidosis. Our patient's leg ulcers have responded well to immunosuppressive therapy with tapered corticosteroid and low-dose azathioprine.