Tofacitinib-Induced Steroid-Free Remission in Subcutaneous Sarcoidosis With Neurologic Involvement: A Case Report

We report the case of a 62-year-old woman with subcutaneous sarcoidosis and probable neurologic involvement who achieved complete remission with tofacitinib without the use of systemic corticosteroids. The patient presented with multiple firm subcutaneous nodules on the extremities and limb weakness. Skin biopsy demonstrated non-caseating granulomas, and electromyography revealed neurogenic changes consistent with C5-C6 nerve root involvement. Treatment with tofacitinib 5 mg twice daily in combination with methotrexate 7.5 mg weekly led to complete resolution of both cutaneous lesions and neurologic symptoms within two months. Tofacitinib was discontinued after eight months, and remission was sustained at 11-month follow-up. This case illustrates the potential of JAK inhibition as an effective steroid-sparing therapeutic strategy in the management of multisystem sarcoidosis.