LAUSR

CASE REPORT A 51-yeareold, otherwise healthy, woman was referred to the Tattoo Clinic with a painful and pruritic swelling of her recently red-tattooed lips. The cosmetic tattoo was placed 6 months prior to her visit to the patient clinic, and her first symptoms occurred 2 months after the tattooing procedure. Because of the painful swelling, she had difficulty eating and talking, which had a significant impact on her quality of life. On physical examination, both the entire upper and lower lip showed erythematosquamous plaques, sharply confined to the red-tattooed mucosa (Fig 1, A and B). After follow-up weeks later, the reaction had evolved into ulcerative plaques (Fig 1, C ). There was no lymphadenopathy. Histopathology of a skin biopsy specimen revealed a lymphohistiocytic, nonsarcoid, granulomatous infiltrate surrounding the red tattoo pigment. ZiehlNeelsen and periodic acideSchiffediastase stains were negative. Serum angiotensin-converting enzyme was within the normal range. Chest X-ray showed no signs of sarcoidosis or other abnormalities. Repeated cultures for bacteria and fungi were negative. Polymerase chain reactions for herpes simplex virus and varicella-zoster virus were also negative, as was serology for HIV.