26380 A case of cutaneous T-cell pseudolymphoma within a tattoo

Abstract

A 53-year-old female with a history of systemic lupus erythematosus, hypertension, and diabetes mellitus type 2 presented with a 4-year history of red, pruritic nodules at the site of a tattoo originally placed 25 years prior on the right lower leg. Treatment with intralesional corticosteroids for 8 months led to improvement of the lesion and associated itch; however, the lesion recurred after discontinuation of the therapy. Physical examination revealed two 3-4 cm firm, erythematous to hyperpigmented smooth nodules confined to the red pigmented sites within the tattoo on the right lower anterior extremity. A punch biopsy demonstrated irregular epidermal acanthosis and spongiosis with exocytosis of lymphocytes into the epidermis. A diffuse dermal infiltrate of small lymphocytes with admixed plasma cells, histiocytes, and foamy giant cells was observed involving a fibrotic dermis and extending into the subcutis. A methenamine silver stain and Fite were negative. On immunohistochemical staining, the infiltrate predominantly expressed CD3+ with a few scattered CD20+ B-cells. A diagnosis of cutaneous T-cell pseudolymphoma was made. The patient was subsequently referred to plastic surgery where she underwent a full excision with split-thickness skin graft. We present this case of pseudolymphoma within a tattoo to highlight that tattoo ink is a risk factor for adverse immunological reactions including cutaneous pseudolymphoma. Pseudolymphoma is a rare benign reactive inflammatory infiltrate that often clinically and histologically mimics cutaneous lymphoma. The reaction inflammatory cell infiltrate can be predominantly T-cell or B-cell or mixed. Early recognition and skin biopsy is imperative for proper diagnosis and management.