Tattoo pigment can precipitate numerous inflammatory states, and granulomatous tattooreactions are a diagnostically challenging form. The skin is the most common site ofinflammation, but systemic inflammation can occur. Reactions to black tattoo ink have abroad differential of cutaneous and systemic conditions. Sarcoidosis is an importantconsideration because it is unclear whether it is a separate entity. Here we present a31-year-old male who developed an inflammatory eruption where he had black tattoos. Healso developed circular patches of scalp alopecia, monocular uveitis, and an enlargedaxillary lymph node, initially thought to represent lymphoma. Tissue biopsy of the skinand lymph node revealed findings consistent with granulomatous tattoo reaction.Investigations for other diagnoses, including sarcoidosis, were negative. He was treatedwith systemic corticosteroids and then with topical corticosteroids and oralhydroxychloroquine. This case report demonstrates the diagnostic challenge associated withgranulomatous tattoo ink reactions. Further studies are needed to improve characterizationand management of this condition.
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