National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 16 1 2017 01 01 Adalimumab-Responsive Refractory Sarcoidosis Following Multiple Eyebrow Tattoos: A Case Report 80 83 242184 EN Alireza Mirzaei Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran, Mohamad Mehdi Joharimoghadam Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mozhdeh Zabihiyeganeh Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran, Journal Article 2021 02 10 Sarcoidosis is a granulomatous disease that can involve multiple organs including the lungs, eyes, nerves, and skin. Cosmetic tattooing can be a predisposing factor for sarcoidosis, and its incidence is likely to increase along with its popularity. A 47-year-old woman with symptoms of fever and polyarthritis along with erythema nodosum lesions on the legs, swollen eyebrows, and a history of multiple eyebrow tattooing was referred to our center. Since the signs and symptoms were positive for Löfgren’s syndrome triad including erythema nodosum, bilateral hilar lymphadenopathy, and polyarthritis, a diagnosis of acute sarcoidosis was made, and treatment was started accordingly. The patient was unresponsive to routine therapeutic agents used for sarcoidosis; however, she successfully responded to adalimumab. Our case indicates that systemic sarcoidosis could develop as a reaction to cosmetic tattooing, which might be refractory to conventional therapeutic agents including corticosteroids and non-biologic disease-modifying antirheumatic drugs, while tumor necrosis factor antagonists such as adalimumab, could lead to disease remission. https://www.tanaffosjournal.ir/article_242184_81da6a1a4738010f74abef9edcf259f5.pdf