Systemic sarcoidal reaction in tattoo

Abstract

Summary Following extensive tattooing, a 31‐year‐old man developed symptoms similar to those of systemic sarcoidosis. Histological examination of the skin lesions, regional lymph nodes and the lung tissue revealed noncaseating granulomatous reaction. Uveitis was also observed, Electron microscopic examination of lung specimens revealed fragments of red tattoo granules. X‐ray microanalysis of the pigment granules observed in red skin and lung lesions showed elements of mercury, aluminium and silicon. The finding of tattoo pigments in the lung tissues has not been previously described.

The granulomatous reaction pattern

“…171 Silica-rich birefringent particles have also been described in lesions without a history of injury or silica exposure. 178,179 Other granulomatous complications of tattoos include tuberculosis cutis and leprosy. 173 The granulomas are thought to develop as a response to colloidal silica particles and not as a result of a hypersensitivity reaction.…”

Systemic Sarcoidosis and Red Dye Granulomatous Tattoo Inflammation after Influenza Vaccination: A Case Report and Review of Literature

“…The limitation to the red areas indicates that this is more than the previously described Koebner phenomenon. If our case were simply a case of severe delayed tattoo dye hypersensitivity as in the Hanada et al 7 cases, then we would expect foreign birefringent particles to be present not only in the cutaneous punch biopsy, but also in EBUS-TNA and BAL specimens. We suspect that the sarcoidal reaction in this case was the result of an immunologic cascade to the foreign red-dye tattoo antigen.…”

“…The patient was successfully treated with systemic immunosuppressive agents. Hanada et al 7 documented 3 cases of bilateral uveitis, BHL, and red dye-specific tattoo noncaseating granulomatous inflammation. However, aluminum, mercury, and silicon were found within the bronchial biopsy specimen.…”

“…2,[7][8][9][10] Modern red pigment alternatives such as cadmium selenide (cadmium red), ferric hydrate (sienna/red ochre), and organic vegetable dyes such as brazilwood and sandalwood are still causing red dye hypersensitivities.…”

Cutaneous Hematopathology

“…Some cases of sarcoidal granulomatous response to tattoo granules (Fig. 13.16 ) or silicone implants may be followed by subsequent development of more widespread sarcoidosis, further supporting a systemic rather than localized disease in these patients (Hanada et al 1985 ;Teuber et al 1994 ).…”