We document the case of a young woman with an 8-year history of sarcoidosis managed with low doses of prednisone, who presented with leu-cocytoclastic and medium-size vessel vasculitis. She developed first a hemorrhagic stroke, followed by malignant hypertension and gangrene of the limbs requiring multiple amputations. Vasculitis preceding or associated with sarcoidosis is an uncommon event, rarely leading to a life-threatening complication requiring intense immunosuppressive therapy. In this patient, otherwise unexplained severe vasculitis occurred during low dose corticosteroid therapy and in the absence of active sarcoidosis. Vasculitis must be considered a cause of various complications in patients with sarcoidosis.