A 20-year-old man in China may be anxiously reassessing his chances of eternal damnation after the cross he had tattooed on his neck inexplicably vanished after five months and was replaced by an aggressive necrotic ulcer and grave inflammation. The case is so strange that doctors say it “expands the spectrum of tattoo-associated pathology.”
In an uncanny case report published Thursday in JAMA Otolaryngology–Head & Neck Surgery, the man’s doctors noted the multiple ways in which his lesion was striking. First, they could find no trace of an infection. The pigment used for the tattoo, which was red, had disappeared from his skin, leaving just scarring behind in places not yet covered by the ulcer. This isn’t entirely unusual; in normal cases of people having a bad reaction to a tattoo, pigment has been known to migrate into lesions or lymph nodes. But in this case, there was no sign of the red ink, even with deeper digging.
When people’s bodies reject tattoos, the abnormal immune reactions usually stay in the upper layers of tissue, and they almost never cause tissue death. But the man’s lesion went deep and was clearly an invasive, crusty, bleeding necrotic ulcer. Moreover, doctors could also see that his neck was swollen on either side of the lesion. Magnetic resonance imaging (MRI) showed that large masses had formed on both sides of the ulcer and below it. The masses were all in the ballpark of 4 cm by 3 cm, and they were eclipsing his jugular veins. Subsequent scans with enhanced computed tomography showed the internal jugular veins on both sides of his neck had formed clots.