Adalimumab-Responsive Refractory Sarcoidosis Following Multiple Eyebrow Tattoos: A Case Report


1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran,

2 Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.


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.