At Trauma and Orthopaedics, NHS, in Greater Glasgow and Clyde, the doctors treated a woman for chronic pain in her left hip, knee and thigh some months after she had a tattoo.
She had been taking drugs to dampen her immune system following a double lung transplant for cystic fibrosis in 2009.
Her right leg had been tattooed several years earlier, with no ill effects, and she decided to have another large, colourful tattoo on her left thigh.
It is well known some inks or colourants, commonly red ink and those that use heavy metals, can cause a reaction. Tattooing has also been linked with complications ranging from mild skin irritation to systemic infection.
This woman developed an immediately mild skin irritation, which was not unusual. But nine days later she began to feel strong pain in her thigh and her left knee swelled.
The symptoms were so severe she needed powerful painkillers. These drugs helped a little, but her symptoms persisted and were still a problem 10 months later.
She was investigated thoroughly but no cause could be found. A biopsy of her thigh muscle did reveal chronic muscle inflammation – inflammatory myopathy – which is often accompanied by muscle weakness and pain.
This can arise spontaneously, but in her case it seemed likely to be linked to the tattoo process compounded by her compromised immunity.
Although her doctors cannot prove it, they say the timing and the site of the symptoms correlated well with the tattoo and no other causes could be found.
Physiotherapy strengthened her thigh muscles and over the following months she began to improve. Three years after the tattoo, she was pain free.
Not everything is known about the adverse effects of tattoos. Late last year, a German study showed how nanoparticles from tattoo ink can travel into the lymph glands.
Three weeks later, an Australian case study published a photograph showing how black ink from an old tattoo had gradually drained into a lymph gland and turned it black.
The doctors warn that people with compromised immune systems should be aware of the potential risks as they are at increased risk of skin infections.
This is the first documented case of inflammatory myopathy as a complication following tattooing in an immuno-suppressed person.
Just as it could be a rare occurrence, they say it could represent an underdiagnosis for patients presenting with similar symptoms following a tattoo.