Nail involvement in sarcoidosis is rare, and usually observed in patients with systemic or cutaneous sarcoidosis. Treatment is often difficult with no clear guidelines and usually involves targeting systemic or cutaneous symptoms. In addition, nail sarcoidosis is often associated with underlying bony involvement and should warrant imaging in newly diagnosed patients. We present a case report of a 47-year-old male with a history of systemic sarcoidosis presenting with 1 year duration of nail dystrophy of his left big toenail. Biopsy of the nail revealed sarcoidosis of the nail. Interestingly, our patient did not have any osseous abnormalities of the underlying phalanx.