Late Onset Pseudolymphomatous Reaction to Blue Tattoo Pigment Precipitated by Covid Vaccination

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Malvika Ramesh
Landon Hope
Richard Hope
Clay Cockerell


pseudolymphoma, tattoo ink, tattoo reaction, cutaneous reaction, pseudolymphomatous reaction


Tattoos can lead to a variety of cutaneous conditions such as allergic or contact dermatitis,  lichenoid dermatitis, pseudolymphomatous reactions and granulomatous responses such as foreign body granulomas that may have a sarcoidal histology simulating sarcoidosis.[1] Pseudolymphomatous reactions are less common and may clinically and histologically resemble cutaneous lymphomas. Pseudolymphomatous reactions may develop in response to injections, Borrelia infections and arthropod bites. Diagnosis of cutaneous  pseudolymphoma is usually based on clinicopathologic correlation coupled with skin biopsy and ancillary tests such as immunoperoxidase stains and genetic testing when necessary.  Treatment is generally successful with application of topical corticosteroid preparation or injection of intralesional corticosteroids and in some cases, surgical excision. Here, we describe the case of a 61-year-old male who presented with 3-4 mm papules contained within the blue region of a multicolored tattoo on his upper right arm that had been present for several years.  The reaction developed shortly following a Covid vaccination.


1. Pasolini G, Ghidini P, Arisi M, Pedretti A, Ungari M, Pinton PC. Pseudolymphoma tattoo-induced. Dermatol Reports. 2011 Nov 29;3(3):e47. doi: 10.4081/dr.2011.e47. PMID: 25386299; PMCID: PMC4211496.Brady BG, Gold H, et al. “Self-reported adverse tattoo reactions: a New York City Central Park study.” Contact Dermatitis. 2015;73:91-9.

2. Mitteldorf C, Kempf W. Cutaneous Pseudolymphoma. Surg Pathol Clin. 2017 Jun;10(2):455-476. doi: 10.1016/j.path.2017.01.002. Epub 2017 Mar 22. PMID: 28477891.American Academy of Dermatology. “Dermatologist warns consumers about complications linked to newer tattoo inks.” News release issued March 1, 2013. Last accessed July 20, 2018

3. Campolmi P, Bassi A, Bonan P, et al. Cutaneous pseudolymphoma localized to black tattoo. J Am Acad Dermatol. 2011;65(5):e155–7.

4. Amann U, Luger TA, Metze D. Lichenoid pseudolymphomatous tattooing reaction. Hautarzt Z Für Dermatol Venerol Verwandte Geb. 1997;48(6):410–3.

5. Kahofer P, El Shabrawi-Caelen L, Horn M, Kern T, Smolle J. Pseudolymphoma occurring in a tattoo. Eur J Dermatol. 2003 Mar-Apr;13(2):209-12. PMID: 12695144.

6. Gutermuth J, Hein R, Fend F, Ring J, Jakob T. Cutaneous pseudolymphoma arising after tattoo placement. J Eur Acad Dermatol Venereol. 2007 Apr;21(4):566-7. doi: 10.1111/j.1468-3083.2006.01964.x. PMID: 17374006.

7. Patrizi A, Raone B, Savoia F, Bacci F, Pileri A, Gurioli C, Neri I. Tattoo-associated pseudolymphomatous reaction and its successful treatment with hydroxychloroquine. Acta Derm Venereol. 2009;89(3):327-8. doi: 10.2340/00015555-0639. PMID: 19479145.

8. Insect Bite–like Reaction in Patients With Hematologic Malignant Neoplasms Aviv Barzilai, MD, MSc; Dorit Shpiro, MD; Iris Goldberg, PhD; et alYasmin Yacob-Hirsch, MSc; Carlos Diaz-Cascajo, MD; Dina Meytes, MD; Regina Schiby, MD; Ninette Amariglio, PhD; Henri Trau, MD. Arch Dermatol. 1999;135(12):1503-1507. doi:10.1001/archderm.135.12.1503; Indian J Dermatol Venereol Leprol. 2001 Mar-Apr;67(2):72-4.

9. Abnormal insect bite reactions: a manifestation of immunosuppression of HIV infection?K Ajithkumar 1, S George, P G Babu.] Covid-19 infection and vaccination may induce a brisk immune response that may be a hyperimmune response in some patients and has been associated with cutaneous inflammatory reactions [ Front. Immunol., 30 September 2021 Sec. Viral Immunology.

10. Hyperinflammatory Immune Response and COVID-19: A Double-Edged Sword Li Yin Tan1,2, Thamil Vaani Komarasamy1 and Vinod RMT Balasubramanian

11. Munavalli GG, Guthridge R, Knutsen-Larson S, Brodsky A, Matthew E, Landau M. "COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment". Arch Dermatol Res. 2022 Jan;314(1):1-15. doi: 10.1007/s00403-021-02190-6. Epub 2021 Feb 9. PMID: 33559733; PMCID: PMC7871141.

12. Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol. 2020 Aug;217:108480. doi: 10.1016/j.clim.2020.108480. Epub 2020 May 24. PMID: 32461193; PMCID: PMC7246018.

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