Multisystemic Granulomatosis Induced by Red Tattoo Pigment: Course Over 10 Years

There is a wide spectrum of complications related to tattooing, among them local and regional granulomatous reactions. We report the well-documented case of a a 46-year old male patient who displayed an acute pseudolymphomatous reaction to the red pigment of a tattoo, followed by a systemic granulomatosis involving the skin, lymph nodes, kidneys, meninges, heart, and ultimately lungs and pleura with a refractory, although indolent, course over more than 10 years. The chronological and spatial sequences of clinical and pathological findings, including mineralogic studies, support the hypothesis of a multi-organ granulomatosis induced by an unknown antigen displayed in the red tattoo ink, in an individual genetically and immunologically predisposed to granulomatous inflammation, rather than a more trivial sarcoidosis with tattoo involvement.