A case of tattoo-related sarcoidosis with generalised lymph node enlargement.

We report the case of a 39-year-old man who was admitted for evaluation of enlarged lymph nodes. A lymph node biopsy showed CD68- and 1α-hydroxylase-positive non-caseating epithelioid granuloma. Sarcoidosis was diagnosed because of mildly elevated angiotensin-converting enzyme levels and hypercalcemia. We noted tattoos (which were created 10 years earlier) on the left upper arm and forearm. It was hypothesised that some component in the tattoos had triggered a systemic foreign body reaction by macrophages, resulting in sarcoidosis. Treatment with steroids was ineffective, but additional treatment with methotrexate plus adalimumab was successful.