A woman with skin lesions in a tattoo

A healthy 32-year-old woman presented with red papules in tattoos on the right upper arm and right ankle as well as on non-tattooed skin of the right knee, existing since 3 months. Histopathological examination of skin biopsies showed granulomatous inflammation, suggestive for sarcoidosis. An X-ray and CT-scan of the thorax showed hilar lymphadenopathy suggestive of sarcoidosis. Skin lesions in tattoos can be the first symptom of systemic sarcoidosis. Further investigation in these cases is recommended.