Tattoo sarcoidosis is a rare clinical entity that shows a sarcoidosis like granuloma developing from tattoo skin and clinical symptoms of systemic sarcoidosis after long term courses of tattoos. Hypersensitivity reaction for metal included in a pigment of tattoo pigment may assume to be the cause of tattoo sarcoidosis.
A man aged 20s developed symptoms similar to those of systemic sarcoidosis after receiving a multicolored tattoo covering the skin of his entire body. He put a tattoo (red, green, black, gray, yellow and gray) over his entire body 10 years ago. There were severely painful subcutaneous masses about 1 cm in size on a brown and green tattoo on back and lower extremities. A biopsy of the part of the nodule showed a foreign body granuloma containing multinuclear giant cells. Photophobia and decreased visual acuity developed afterwards, and he was diagnosed with bilateral iritis. In addition, hilar lymphadenopathy was founded in a chest X-ray and CT, persistent fever also showed. We diagnosed it as sarcoid reaction by the tattoo because of skin epithelioid granuloma, iritis, and bilateral hilar lympadenopathy in CT. After hospitalization, his eyes were injected with dexamethazone and he took oral prednisolone 40 mg/day for iritis. Severe iritis was not improved by administration of only steroids and improved in combinating azathioprine. We report this as the interesting case that showed a sarcoidosis like reaction to the pigment of a tattoo.
A 15-year-old girl was as having SLE concurrent with lupus cystitis since abdominal echography at onset revealed thickening of the vesical wall, increased luminescence of the renal cortex, and slight bilateral hydronephrosis. After inception of medication with prednisolone, initial symptoms and examination findings improved, but the symptoms flared up later and duodenal perforation occurred concurrently without any prodromes. However, her life was saved by an early, appropriate surgical treatment. With combined therapy of prednisolone and cyclosporine-A, the patient has followed a satisfactory clinical course up to the present.
Gastro-intestinal lesions and lupus cystitis have a similar lesional mechanism in terms of pathological features. Gastro-intestrinal lesions are said to develop simultaneous with or preceding to lupus cystitis. In the present case, lupus cystitis was found only at onset, and it improved with treatment, but there was bowel perforation so severe as to have a decisive effect on the life prognosis with the disease activity increasing. In the cases showing lupus cystitis during the clinical course, it seems necessary to make observations on the clinical course while always taking abdominal complications into consideration.
An earthquake with a magnitude of 6.8 (7 on the Japanese shindo scale) hit the Chuetsu area of Niigata prefecture at 17: 56 pm on October 23, 2004, and also frequent aftershocks troubled people for month. The author surveyed the degree of damage for rheumatoid patients under such conditions. No rheumatoid patients were crushed under collapsed houses or killed in landslides, but 2 patients broke their legs and were operated on in our hospital. People in shelters complained they couldn’t sleep because of the cold. Therefore, many of them stayed in their vehicles. This caused the onset of a disease called “economy class syndrome”. In shelters, there were not western-style enough toilets or camp beds for all of the disabled people present. The prescriptions of the patients who lost their drugs or couldn’t go to hospital because of landslides or other problems were faxed to a pharmacy in their area of residence. To prepare for emergencies, doctors should prescribe extra drugs for a few days. It’s hard for doctors to get information about patients’ safety so the author has been suggesting “If you have any trouble, please contact us as a support hospital for rheumatoid patients.”