An Impressive Finding of Sarcoid-Like Reaction to Tattooing.

This case represents an impressive finding of a young male who developed cutaneous sarcoid-like reactions that arose secondarily to tattoo ink. Cutaneous manifestations of sarcoidosis can present themselves in various ways, be caused by different inducing factors, and may present themselves not only cutaneously but as one of the many findings of systemic sarcoidosis. A 24-year-old black gentleman presented to the dermatology clinic with a manifestation of papules in his tattoos that covered a majority of his body. The patient tried hypoallergenic tattoo ink to see if this would prevent the formation of these bumps; however, this only further provoked the production of these papules confined to tattooed areas. Skin findings revealed linear raised papules in a continuous fashion in areas where the patient had tattoo ink on his torso, bilateral arms and legs, and face. At presentation, he denied any constitutional, pulmonary, or ophthalmologic symptoms. Pathological findings revealed sarcoidal granulomatous dermatitis showing nodular non-necrotizing granulomatous inflammatory infiltrate involving the superficial and deep dermis. The patient was then evaluated by pulmonology to rule out any systemic findings of sarcoidosis, which showed a negative chest x-ray. The patient was started on oral prednisone and topical pimecrolimus cream, and when he returned for his one-month follow-up, there were minimal to no visible cutaneous lesions. Tattoo ink has been shown to cause a variety of cutaneous reactions such as infections, neoplasms, and inflammatory dermatoses such as eczema, lichen planus, psoriasis, vitiligo, and sarcoidosis. Cutaneous sarcoid-like reactions secondary to tattoo ink are rare findings; however, they must be taken seriously due to the risk of systemic sarcoidosis involvement both at initial presentation and in the future.

Adult-Onset Immunoglobulin A Vasculitis Following Hemodialysis Treatment: An Unusual Presentation.

Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura (HSP), is a small vessel vasculitis due to perivascular deposition of dominant IgA immune complexes. It classically presents with symptoms such as palpable purpura, abdominal pain, kidney dysfunction, and joint pain. It most commonly affects children less than 10 years old. We present the case of a 53-year-old male who developed purpuric rashes a few hours after receiving hemodialysis. Initially, the lesions were localized to his legs and buttocks. They continued to spread over his back, abdomen, and arms. He experienced joint pain in both of his wrists, as well as abdominal tenderness. Labs revealed elevated IgA levels: 422 mg/dL (normal: 61 - 356 mg/dL). C3, C4, and antinuclear antibody (ANA) levels were within normal limits. Oral prednisone and topical diphenhydramine resulted in significant improvement in his symptoms. To our knowledge, there are only five reports documenting the occurrence of HSP in adults undergoing hemodialysis. Although HSP is a rare finding in adults, recognition of the disease is important as it can cause significant morbidity and mortality if left untreated.