Inoculation (tattoo) leprosy: a report of 31 cases

Abstract

Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.

Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - Part 1

“…30-32 Less commonly, transmission can occur by skin erosions. 32,33 Other transmission routes, such as blood, vertical transmission, breast milk, and insect bites, are also possible. 29,34-36 …”

<i>Mycobacterium abscessus</i> Skin Infection after Tattooing: First Case Report and Review of the Literature

“…These organisms can cause skin and soft tissue infections after surgical procedures, trauma and injections with nonsterile instruments [4]. Tattooing is rarely incriminated in mycobacterial infections [5,6,7], and M. abscessus has never been isolated after tattooing. We describe a case of M. abscessus skin infection diagnosed in an otherwise healthy Brazilian man a few days after a tattoo session.…”

Vaccination scar, skin lesion, and tattoo design

“…There have also been scant reports of leprosy lesions developing at the site of vaccination and injury . However, it is not easy to pinpoint the mode of acquisition of infection in this particular case, as the period between entry of the organism (through vaccination scar as well as tattooing) and development of leprosy lesion can vary from a few years to a few decades . The author has earlier reported inoculation indeterminate and tuberculoid leprosy at the site of vaccination scar from this highly endemic region for leprosy .…”

“…The blue–black tattoo was done at the time of marriage at about 17 years of age, through shared needles and roadside tattooing along with other three women. Owing to several misconceptions, it is customary for girls to be tattooed, usually at the time of marriage . Besides their ornamental value, tattoos in Chhattisgarh are also presumed to protect from the evil eye, to ensure a smooth passage of the soul, as an identification mark for self/husband, and to camouflage patches of vitiligo and leprosy and to restrict the latter's spread.…”

“…It is pertinent to emphasize that the complication seen here might have happened while performing either vaccination or tattooing, through use of contaminated, unsterile needles. Infectious bacterial diseases such as leprosy or tuberculosis can occur as complications after procedures of body ornamentation (piercing, tattooing) …”