Doctors in Australia suspected that a woman had a type of cancer called lymphoma, but they were surprised when they enlarged the lymph node and found a black tattoo pigment from 15 years ago to which her immune system recently started reacting.
The case was reported and released on Monday in the journal, Annals of Internal Medicine, CNN reported.
The 30-year-old woman had come in with small lumps under her arms, which had been there for two weeks. Her body scan showed even more enlarged lymph nodes in her chest, including near the roots of her lungs.
Dr Christian Bryant, a hematologist at the Royal Prince Alfred Hospital in Sydney said, “Ninety-nine times out of 100, this will be lymphoma.”
In the case of this woman, whose name was not released, her lymph nodes were inflamed because of a reaction to the old tattoo ink, not due to cancer cells. Doctors removed a lymph node from her armpit and found a cluster of immune cells that were loaded with black pigment. The woman had a 15-year-old tattoo covering her back, and there was a smaller, more recent one on her shoulder.
“The skin has its own immune cells that are always surveilling the skin,” said Dr Bill Stebbins, director of cosmetic dermatology at Vanderbilt University Medical Center, who was not involved in the report.
Once these immune cells found the tattoo pigment, a foreign substance, they ingested it and traveled from the skin to the lymph nodes over a period of years. “The pigment is too large for these cells to eat and digest,” the doctor shared saying. “That’s why they’re still there many years later.”
But why the woman had a reaction 15 years after her tattoo is a mystery. Something set off the immune cells, but her doctors couldn’t pin down what that trigger might be, Bryant said. The patient noted that her tattoos would occasionally itch, but only for a few days each month. The type of inflammatory response found in her lymph nodes, called a granuloma, was not found in her skin.
Bryant and his colleagues had never seen anything quite like it. Other reports have described swollen, pigmented lymph nodes that were mistaken for melanoma, but this is the first time they had heard of a case with lymph nodes deep enough to fit the picture of lymphoma. “I think there’s absolutely no way to know how common it is,” Bryant said. “Most people who have tattoos have absolutely no problems.”
“We do a lot of tattoo removal with lasers in our practice, and sometimes we see people developing allergic reactions to the ink,” said Dr Bruce Katz, a fellow with the American Academy of Dermatology and director of the Juva Skin and Laser Center in Manhattan. Katz was not involved with the new report.
But these reactions are usually to red pigments, not black.
For those looking to get inked, Katz said, it’s crucial to do your research: make sure the artist is reputable, get references from clients, and ensure that they are using disposable needles and unopened ink to prevent infections.