Infection of tattoos by AFB (acid-fast bacilli), usually M chelonae, has increased in incidence recently. It is thought that the infection results from colonized tap water used to dilute the black tattoo ink to the desired gray color. However, some well-documented cases have occurred from contaminated premixed inks. See tattoo for other diagnostic considerations.
Usually 1-2 weeks after the placement of the tattoo, pink, red, or purple papules, papules with scale, pustules, granulomatous papules, and/or lichenoid papules and plaques develop. Onset can be delayed as long as 5 months after placement. Lesions may be confined to the gray-colored areas of the tattoo.
Macrolide or quinolone antibiotics have been used, e.g., clarithromycin 500 mg twice a day for 3-5 months. Treatment may be lengthy. Multidrug-resistant organisms have been identified. Consultation with an infectious disease expert is recommended. Obtaining tissue culture and sensitivities to direct therapy is important.
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