Intestinal microflora and sarcoidosis are related to the similarity of histological findings in granulomas of sarcoidosis with leprosy, tuberculosis and parasitic infections. The lung microbiome in patients with sarcoidosis is different from that of healthy individuals, but the results of studies are conflicting, showing the abundance or decrease of bacteria and fungi. Altered microbiome composition may contribute to granuloma formation through interactions with the immune system. No microbe has been unequivocally proven to be the cause, but various microorganisms have been detected in granulomas and organ tissues, particularly at the genomic level. A meta-analysis of more than 6,000 patients identified a strong association between Cutibacterium acnes, Mycobacterium tuberculosis, and sarcoidosis. Studies support microbial involvement through activation of the innate immune system and increased secretion of inflammatory cytokines. Some research suggests that restoring the gut microbiome could be a therapeutic approach, although the causal role of microbes is not conclusively established. The review elucidates microbial roles in pathogenesis and compares the lung microbiota with sarcoidosis and other interstitial lung diseases.