Glasgow rangers lymphadenopathy

Abstract

A 23-year-old kick boxer was referred for assessment of persistent lymphadenopathy affecting his groins and axillae over a 12-month period. He was otherwise entirely well and without B symptoms. The palpable nodes were non-tender and were of variable size up to 2 cm diameter; the liver and spleen were not palpable. He was noted to have multiple non-inflamed tattoos sited over his left shoulder, abdomen and upper right chest; the latter indicating his affiliation with a local football team (above left). Laboratory investigations including full blood count, urea and electrolytes, liver enzymes and lactate dehydrogenase were normal but, in view of the duration of the lymphadenopathy, we proceeded to excision biopsy of a groin node. The appearances were of a reactive lymph node with sinus histiocytosis and follicular hyperplasia. In particular, there was a prominence of dark pigment within the paracortex (arrows, above right) associated with a reactive increase in Langerhans cells. We concluded that the widespread lymphadenopathy was reactive to tattoo pigment which had undergone regional lymphatic migration, perhaps encouraged by the trauma of kick boxing bouts. He remains clinically well after a further year of follow-up but the lymphadenopathy is unchanged. Tissue reactions to tattoos are rare and not well recognized. They are usually localized either to the site of the tattoo itself or to the regional draining lymph nodes. Tattoo inks are made from a variety of metal salts suspended in a carrier solution. The red inks made from iron and mercury compounds are most likely to generate a reaction. The blue/black pigment seen in this lymph node was likely to have been generated from salts of iron, cobalt and carbon. Although reactions can occur with any colour of ink the followers of the other Glasgow football team might suggest that the use of green pigment would be unlikely to cause any unpleasant reaction.