Glasgow rangers lymphadenopathy

A 23-year-old kick boxer was referred for assessment of

persistent lymphadenopathy affecting his groins and axillae

over a 12-month period. He was otherwise entirely well and

without B symptoms. The palpable nodes were non-tender and

were of variable size up to 2 cm diameter; the liver and spleen

were not palpable. He was noted to have multiple non-inflamed

tattoos sited over his left shoulder, abdomen and upper right

chest; the latter indicating his affiliation with a local football

team (above left). Laboratory investigations including full

blood count, urea and electrolytes, liver enzymes and lactate

dehydrogenase were normal but, in view of the duration of the

lymphadenopathy, we proceeded to excision biopsy of a groin

node. The appearances were of a reactive lymph node with sinus

histiocytosis and follicular hyperplasia. In particular, there was

a prominence of dark pigment within the paracortex (arrows,

above right) associated with a reactive increase in Langerhans

cells. We concluded that the widespread lymphadenopathy was

reactive to tattoo pigment which had undergone regional

lymphatic migration, perhaps encouraged by the trauma of kick

boxing bouts. He remains clinically well after a further year of

follow-up but the lymphadenopathy is unchanged.

Tissue reactions to tattoos are rare and not well recognized.

They are usually localized either to the site of the tattoo itself

or to the regional draining lymph nodes. Tattoo inks are

made from a variety of metal salts suspended in a carrier

solution. The red inks made from iron and mercury

compounds are most likely to generate a reaction. The

blue/black pigment seen in this lymph node was likely to

have been generated from salts of iron, cobalt and carbon.

Although reactions can occur with any colour of ink the

followers of the other Glasgow football team might suggest

that the use of green pigment would be unlikely to cause any

unpleasant reaction.

Mike Leach1

Robert Jackson2

Edward J. Fitzsimons1

Departments of 1Haematology, and 2Haematopathology, Gartnavel

General Hospital and Glasgow Royal Infirmary, Glasgow, UK

E-mail: mike.leach@ggc.scot.nhs.uk

images in haematology

First published online 07 January 2011doi:10.1111/j.1365-2141.2010.08441.x ª 2011 Blackwell Publishing Ltd, British Journal of Haematology, 152, 504