Sarcoidosis Makes Its Mark?


Did the young man's tattoo cause sarcoidosis, or merely exhibit it? A case study in NEJM leaves the question open.

Torres LK and Faiz SA. Images in Clinical Medicine: Tattoos and Sarcoidosis. N Engl J Med 2014; 370:e34 June 5, 2014 DOI: 10.1056/NEJMicm1215331

It's not entirely clear from this remarkable case study whether the tattoo caused the reaction, but it's known that sarcoid granulomas can infiltrate tattoos and scars.

The 29-year-old man presented with an acute onset of right pleuritic chest pain and a three-month history of dyspnea, cough, and skin lesions. He had crackles in both lungs and papules along the ink lines of a tattoo.

A chest radiograph showed a right perihilar infiltrate, with bilateral hilar lymphadenopathy, with reticulonodular opacities. Bronchoscopy showed nodules in the tracheobronchial mucosa. Skin biopsy showed both noncaseating granulomas and black tattoo pigments.

The man’s respiratory symptoms improved with systemic glucocorticoids. He was lost to follow-up.


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