Ink sick: Tattoo ink hypersensitivity vasculitis

Abstract

This case describes a rare cause of vasculitis due to a hypersensitivity reaction to tattoo ink in a young man. This 21-year-old male sailor with no medical problems received a new tattoo on his right calf 2 weeks before presentation. He complained of a painful, pruritic rash on his legs for 1 week, most pronounced around the site of the tattoo. He also reported chills, arthralgias, and myalgias for the preceding 3 days. Despite treatment with loratadine and prednisone for presumed contact dermatitis by his primary care manager, the patient developed significant edema of his left hand and right ankle as well as rigors, prompting his presentation to the emergency department. The purpuric eruption was limited to his lower extremities (Figs. 1-3). His history and physical examination were unremarkable except where noted above. Although vasculitis is relatively common, tattoo ink hypersensitivity vasculitis is extremely rare. The most common complication of tattooing is cellulitis. Punch biopsy of this patient revealed leukocytoclastic vasculitis, which is consistent with previously published tattoo ink vasculidites [1,2]. The most common ink color precipitating cutaneous reactions to tattoos is red, as seen in this tattoo. Interestingly, the patient had previously received other less colorful tattoos without adverse effect. This presentation is similar to a case published by Hermida et al [3], which was the first of its kind. Our patient was admitted to the hospital and treated with systemic corticosteroids for 4 days. He was discharged with ☆ There was no financial support or grant for this paper. ☆☆ The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. ★ Government or non–copyright protected forum. I am a military service member. This work was prepared as part of my official duties. Title 17 USC 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 USC 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.—MJH 0735-6757/$ – see front matter © 2011 Published by Elsevier Inc. prednisone and colchicine. Although his skin manifestations and arthralgias improved, he required crutches for ambulation 4 weeks after initial presentation. Fig. 2 Bilateral lower extremity purpuric lesions. Fig. 3 Close up of right ankle lesions. 1237.e4 Case Report Mary Josephine Hessert DO John Devlin MD Department of Emergency Medicine Naval Medical Center Portsmouth Portsmouth, VA USA E-mail address: maryjo.hessert@med.navy.mil doi:10.1016/j.ajem.2010.08.030