Tattoo-Induced Cutaneous Pseudolymphoma: A Rare Case of Reactive Lymphoid Hyperplasia

Summary: Tattoo-induced cutaneous pseudolymphoma (CPL) is an uncommon but significant complication linked to tattoo placement. This case report describes a 40-year-old male who presented with a 5mm erythematous papule over a black-ink tattoo on his right shoulder. The lesion, asymptomatic and stable for one year, was evaluated with dermoscopy. Given the non-diagnostic dermoscopy findings, a shave biopsy was performed as the clinical differential diagnoses included keratinocyte carcinoma. Subsequent histopathological analysis demonstrated a dense, mixed T-cell and B-cell lymphocytic infiltrate, with immunohistochemical stains revealing a predominant CD4+ T-cell population and scattered CD20+ B cells. Infectious stains, including GMS and AFB, were negative, in keeping with a diagnosis of tattoo-induced CPL. Tattoo-induced CPL is rare, comprising approximately 26% of CPL cases, with varied clinical presentations. The condition is associated with significant diagnostic challenges due to its histological overlap with lymphoproliferative disorders. Current management strategies include surgical excision, though alternatives such as topical or injectable steroids are explored based on individual patient factors. This case underscores the need for awareness of tattoo-related complications and highlights the importance of recognizing CPL to guide appropriate diagnosis and management.