CLINICAL A 57-year-old man underwent re-pigmentation of 4-year-old tattoos on his arms. The red areas were injected with a combination of yellow cadmium sulfide and red mercuric sulfide containing dyes. Four months later, while on vacation in Costa Rica, he sustained sunburn to his arms. Ten days later, after resolution of his sunburn, he noticed swelling, weeping, and pruritus limited to the red areas of his tattoos. The presented biopsy and clinical photographs were taken after his return to Canada 2 months later. His chest X-ray is normal and he has no evidence of systemic sarcoidosis.
HISTOLOGY Lichenoid inflammation is associated with epidermal acanthosis and a dense dermal inflammatory infiltrate that contains plasma cells and granulomas. A palisaded necrobiotic granuloma is present at the edge of most of the recut slides. Tattoo pigment cannot be seen on the H & E stained sections.
IMPORTANT FEATURE: REASON FOR PRESENTATION The tattoo’s inflammatory response includes previously undescribed palisaded necrobiotic granulomas.

REFERENCES

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