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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2991 - 23 December 2021 Posted By: Saleem Taibjee

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45F. punch biopsy right shoulder - lumpy change developing in a longstanding tattoo (20 years later).

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Non caseating epithelioid cell granulomas suggest sarcoidosis developing in a tattoo. This could be due to a prolonged antigenic stimulation or development of scar sarcoidosis in a predisposed individual. A search to rule out systemic sarcoidosis is warranted. 

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Saleem Taibjee


Yes, this is a recent case I have reported of sarcoidal-type granulomatous reaction to tattoo pigment. It is interesting to note the long time interval between original tattoo and onset of reaction. As you have pointed out, it is important to investigate for underlying sarcoidosis in such cases.

BW, Saleem

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