Tattoo ink may be contaminated with atypical mycobacteria. Atypical mycobacteria may be present as a contaminant in water supplies. The diagnosis may be missed or delayed.
Atypical mycobacteria that could be in tattoo ink include:
(1) M. chelonae
(2) M. fortuitum
(3) M. abscessus
(4) M. marinum
Risk factors:
(1) improper production of the ink (unopened bottle of ink positive for the same atypical mycobacteria as isolated from patients)
(2) dilution of the ink with water by the tattoo artist (water source positive for the same atypical mycobacteria as isolated from patients)
(3) cross-contamination between ink bottles
Clinical features:
(1) papules or nodules at or adjacent to a tattoo
(2) skin ulceration at or adjacent to a tattoo
(3) soft tissue abscess at or adjacent to a tattoo
(4) disseminated disease if the patient is immunodeficient
Differential diagnosis:
(1) allergic reaction to tattoo ink
(2) other infection related to the tattoo
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