Granulomatous tattoo reaction in a young man

Skin involvement in sarcoidosis occurs in 20-35% of cases, usually in early stages of the disease, providing a valuable opportunity for timely diagnosis.1,2 The first report that related tattoos to systemic sarcoidosis was published in 1955,3 and 32 reports in total were published before 2012. Sarcoid lesions usually occur in the red (cinnabar), black (ferric oxide), and blue-black areas of tattoos.2 The age of the tattoo before sarcoidal manifestations is widely variable and ranges from months to decades.3 Chronic low-grade exposure of the immune system to an antigen substance in the foreign material might ultimately lead to systematised granulomatous hypersensitivity.4 The association of new-onset pronounced ankle arthritis and bilateral hilar lymphadenopathy without erythema nodosum, especially in men, has been suggested as a variant of Löfgren's syndrome, and this pattern of illness has an excellent prognosis.5 Tattoo sarcoidosis, as described in our patient, could be the first manifestation of sarcoidosis.