Nontuberculous (atypical) mycobacteria rarely cause skin and soft tissue infections. Tattooing with contaminated gray ink has been implicated in previously reported outbreaks. We report the case of a 39-year-old Hispanic male who presented with a refractory, pruritic, papular eruption within the distribution of his tattoo with punch biopsy demonstrating papillary dermal granulomatous and suppurative inflammation surrounding small collections of acid-fast bacilli with associated superficial and deep dermal perivascular lymphatic inflammation, consistent with nontuberculous mycobacterial infection. Although uncommon, clinicians should consider nontuberculous mycobacterial infection in the differential diagnosis of refractory tattoo-associated skin eruptions.