Sarcoidosis in A. C. Milan (1899)?



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Title: Sarcoidosis in A. C. Milan (1899)?
Abstract: The authors "present a patient with a tattoo of AC Milan (1899) on his right arm, who subsequently developed localised sterile sarcoid granulomas in the area of the tattoo. Later the process became generalised on his whole body's skin, lungs and lymph nodes. It is unclear for the moment whether this condition should be interpreted as sarcoidosis as an autonomous disease or, instead, as a sarcoidal type of reaction with subsequent generalisation due to cross-reactivity against antigens present in other tissues with similarities to the exogenous pigments.

Following the modern concepts regarding the pathogenesis of these two conditions, we introduced, in this case, an innovative, non-standard approach:
1) systemic and local immunosuppressive therapy, combined with
2) recommendation for immediate surgical excision of the tattoo to remove the possible trigger of molecular and antigen mimicry."
Industry Significance Rating: High - Industry alert, report has major implications related to health and safety.
Publication: Macedonian Journal of Medical Sciences. 2018 Jan 13;6(1):99-102.
Authors: Tchernev G, Lotti T, Wollina U, Cardoso JC, Popova LV, Maximov GK, Lozev I, Terziev I.
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Discussion:

The authors present a case of a patient who initially developed localised sarcoid granulomas in the area of a tattoo and subsequently developed generalised effects (skin, lung and lymph nodes) and at the time of writing questioned if this was a case of sarcoidosis or perhaps "sarcoidal type of reaction with subsequent generalisation".

Several previous authors have considered the possibility of causation when sarcoidosis / sarcoidal type reactions have occurred in association with or secondary to skin reactions in tattoos or if the reaction may be considered a diagnostic marker; in this particular case the authors have taken cautious approach by recommending excision of the tattoo with the intent of minimising the risk of ongoing chemical triggers from the tattoo pigment. It is likely that many medical practitioners may have an interest in the longer term outcome from this type of case particularly due to the more active approach to treatment.

Recommendations:

Clients who develop any form of skin reaction on or near tattooing should be referred to their treating doctor for evaluation.

Keywords:

Medical Report, cutaneous granuloma, exogenous pigment, molecular mimicry, sarcoid - type reaction, sarcoidosis, tattoo

 

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