Case: Tattoo Ink-Induced Lymphadenopathy Misdiagnosed as Cancer

Case report describes patient with multiple enlarged lymph nodes seen on PET-CT years after tattoo
Case report describes patient with multiple enlarged lymph nodes seen on PET-CT years after tattoo

(HealthDay News) — Tattoo pigment hypersensitivity causing widespread lymphadenopathy has been described in a case report published online Oct. 2 in the Annals of Internal Medicine.

Jad Othman, M.B.B.S., from the Royal Prince Alfred Hospital in Australia, and colleagues described the case of a 30-year-old woman reporting a two-week history of bilateral axillary lumps noted on self-examination without fever, night sweats, weight loss, or pulmonary symptoms. She had a large tattoo covering her back that had been present for 15 years and another on her left shoulder that was 2.5 years old.

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The researchers found that the results of all blood tests were within normal ranges, with a mildly elevated erythrocyte sedimentation rate. Multiple enlarged lymph nodes in the axillary, hilar, and mediastinal areas were seen on positron emission tomography-computed tomography (PET-CT). These findings were interpreted as consistent with lymphoma. After nondiagnostic fine-needle aspiration, an enlarged black node was found in excisional biopsy of a left axillary lymph node. The nodal architecture was replaced by well-formed epithelioid granulomas and scattered multinucleate giant cells. Within the paracortex there were collections of black pigment-laden macrophages. The diagnosis was determined to be granulomatous lymphadenitis, which was probably a hypersensitivity reaction to the tattoo pigment.

"To the best of our knowledge, the PET-CT findings of markedly glucose-avid nodes in multiple areas have not previously been described," the authors write. "We believe that this case highlights the importance of a careful tattoo history and physical examination."

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