A patient with sepsis and jaundice was admitted for diagnosis and treatment. Associated biochemical changes included increased C-reactive protein, conjugated bilirubin and gamma-glutamyltransferase, the duration of which was protracted. High urine coproporphyrin isomer-1 and immunostaining of liver tissue suggested Dubin-Johnson syndrome. DNA sequencing using polymerase chain reaction amplification of the ABCC2 gene revealed the patient to have a compound heterozygous variant of MRP2, a molecule involved in canalicular transport of bilirubin. There was a history of jaundice since infancy.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive cutaneous tumour of intermediate grade malignancy. A number of reports have linked local trauma of varying aetiology with the later development of DFSP. In addition, a variety of skin disorders and, in rare cases, cutaneous tumours, have been described in association with decorative tattoos. This is often associated with delayed diagnosis. We report the first case of DFSP arising in a tattoo and discuss the available evidence for a causative link between DFSP and local trauma of this nature.

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