title: [Rose necrosis: Necrotizing granulomatous reaction with infected node at red pigment of a tattoo].
abstract: BACKGROUND
  Nowadays, necrotizing cutaneous reaction after a tattoo is rare especially with the sterile tattoo equipment and antisepsis rules. We report the rare case of a necrotizing reaction secondary to a granulomatous reaction after a red tattoo, with a satellite node.
  
  
  METHODS
  A 40-year-old patient suffering from a granulomatous reaction to red dye of a large pectoral tattoo, with cutaneous and sub-cutaneous necrosis, and an infected axillary node. This pectoral tattoo also triggered a necrotizing granulomatous reaction on red-pigmented areas of other older tattoos. Local treatments (dressings, antibiotics, repeated excisions of necrotizing tissues) did not stop the allergic reaction, and an infectious origin was eliminated. The patient asked for a complete excision of the pectoral tattoo. Black intramacrophagic pigment was found in the black lymph node analysed. We did not experience any complications and the patient is satisfied with the results.
  
  
  CONCLUSIONS
  Very few examples of cutaneous necrotizing secondary to a tattoo have been found in the literature. The hypothesis of a primitive infection that had secondarily led to necrosis is refuted by the lack of infective structures found in the analysed node, and most of all by the same reaction on other older tattoos on red-pigmented areas. This rare complication must be known by plastic surgeons, who will probably be called upon to take care of more and more tattooed patients.
  
  
  CONCLUSIONS
  Even if it's rare, necrosis with a granulomatous reaction to red pigment after a tattoo must be known. This case illustrates a very violent immune reaction where infection was not proved.
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: jonathanfray1@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Fray
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: lekieffreanne@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Lekieffre
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: faby1986@msn.com.
authors.forename: F
authors.initials: F
authors.lastname: Parry
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: vincent.huguier@chu-poitiers.fr.
authors.forename: V
authors.initials: V
authors.lastname: Huguier
authors.affiliation: Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: gerard.guillet@chu-poitiers.fr.
authors.forename: G
authors.initials: G
authors.lastname: Guillet
mesh_terms: D000328:Adult; D004396:Coloring Agents / Q000009:adverse effects*; D006099:Granuloma / Q000139:chemically induced* / Q000601:surgery; D006801:Humans; D008297:Male; D009336:Necrosis / Q000139:chemically induced; D017060:Patient Satisfaction; D010369:Pectoralis Muscles / Q000473:pathology* / Q000601:surgery; D013653:Tattooing / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents
keywords: Adénite; Granulomatous reaction; Infected lymph node; Necrosis; Nécrose; Pigment rouge; Red dye; Réaction granulomateuse; Tatouage; Tattoo