Tattoo-induced pseudolymphoma

ABSTRACT

Introduction Pseudolymphoma is a rare complication of tattooing, presenting with infiltrated areas often at the site of a red tattoo and postulated to be an allergic reaction to mercury salt. When present, it may be mistaken for the more commonly occurring tattoo-associated granuloma. Case summary We describe a 47-year old female who developed nodular areas on her tattoo four months after placement by a professional tattoo artist. The nodules were restricted to the red regions and spared the blue-black areas of tattoed skin. Initial differentials included a foreign body or sarcoidal granuloma and contact dermatitis to the red dye. Histology revealed a top-heavy lymphocytic infiltrate spanning most of the dermis, with numerous eosinophils. Dark red, non-polarisable exogenous pigment was scattered throughout the dermis, in association with the inflammatory infiltrate. The epidermis showed intense spongiosis and eosinophilic exocytosis. A final diagnosis of tattoo-induced pseudolymphoma was made. Pseudolymphoma, foreign body and sarcoidal granulomatous reaction patterns from tattoos occur more commonly in red tattoos. Biopsy with histology is required to differentiate these three disorders with divergent management. We review the literature on tattoo-induced pseudolymphoma and highlight the pitfalls associated with the diagnosis.