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Nodules on nose and tattoos

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Our patient sought treatment for the nodules on his nose, but the nodules on his tattoos proved particularly helpful in making the diagnosis.


 

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A 38-year-old African American man with no significant medical history presented to our dermatology clinic with a 5-month history of nodules on the right side of his nose (FIGURE 1). For several years, he’d also had nodules that gradually appeared on several red-inked tattoos shortly after he received each tattoo (FIGURE 2). He also had a 5-year history of nontender swelling of his fingers.

The patient denied any trauma to the areas with nodules or being in contact with anyone who was sick. He had no respiratory complaints, but chest x-rays from recent and past records showed stable bilateral intrathoracic lymphadenopathy without any lobar infiltration or pleural effusion.

Physical examination revealed 3 reddish-brown soft nodules on the nasal ala and multiple, nontender, 3- to 5-mm firm nodules located in the red-inked areas of tattoos on his arms and neck. The tattoo nodules were asymptomatic and stable in size. He had clubbing of multiple digits and nail dystrophy. His distal fingers were edematous, but nontender. X-rays revealed lytic, lace-like lucencies of the middle and distal phalanges and erosions of the distal phalanges on both hands (FIGURE 3).

We biopsied the nodules on his nose and on one of his tattoos.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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