Histologically proven sarcoid neuropathy is rare and its features are protean. The objectives of this study were to describe a patient with chronic, stable sarcoidosis and new onset of neuropathy and to review the neuropathic manifestations of sarcoidosis. We conducted a case report and review of the literature. A 59-year-old woman with a 9-year history of quiescent sarcoidosis developed progressive distal leg paresthesias over 12 months. Electrodiagnostic studies showed a mild left peroneal neuropathy, and superficial peroneal nerve biopsy revealed evidence of sarcoidosis with vasculitis. Additional investigations revealed unsuspected, active systemic sarcoidosis involving the lungs, salivary glands, and peripheral lymph nodes. Historically, sarcoid neuropathy could present as focal, multifocal, or diffuse sensorimotor neuropathy with predominant axon loss and sometimes vasculitis. Serologic testing has limited value, particularly in patients with known sarcoidosis. Nerve biopsy is required for diagnosis of sarcoid neuropathy, and positive biopsy could lead to recognition of more extensive subclinical multisystem involvement. Fortunately, most patients improve with oral corticosteroids.