Case of cutaneous Sarcoidosis appearing in Tattoos - NEJM

Lisa K. Torres, at University of Texas Health Science Center at Houston, Houston, Texas and colleagues have reported a case of cutaneous Sarcoidosis appearing in Tattoos. The case has appeared in NEJM.

The development of granulomatous lesions within tattoos is a well-recognized occurrence in individuals with sarcoidosis. Cutaneous manifestations may occur in up to one-third of patients with sarcoidosis, and the tendency of sarcoid granulomas to infiltrate old scars and tattoos is well documented. Skin lesions or sarcoidosis involving tattoos may occur even decades after tattooing, possibly as a result of chronic antigenic stimulation from the ink in a person who is genetically predisposed to such lesions.

According to history a 29-year-old man presented with an acute onset of right pleuritic chest pain and a 3-month history of dyspnea, cough, and skin lesions. His physical examination revealed crackles in both lungs and multiple nonerythematous papules along the ink lines of a tattoo.

Courtesy NEJM
A chest radiograph showed a right perihilar infiltrate with bilateral hilar lymphadenopathy (arrows) and reticulonodular opacities (arrowheads). Bronchoscopy revealed diffuse nodules in the tracheobronchial mucosa. The results of tissue stains and cultures for acid-fast bacilli and fungal organisms were negative.

Examination of specimens from a skin biopsy showed noncaseating granulomas and black tattoo pigment. The patient's respiratory symptoms improved with the administration of systemic glucocorticoids, but he was lost to follow-up after discharge.

This case shows that systemic sarcoidosis can present as sarcoidal granuloma formation complicating cosmetic tattooing for the purpose of permanent makeup. The differential diagnosis of skin lesions involving tattoos includes infections, discoid lupus erythematosus, keloid formation, and local reaction.

For more details click on the link: DOI: 10.1056/NEJMicm1215331