The Case: A 25-year-old male presented to the emergency department rapid care center complaining of an infection to his left lower extremity. He had a tattoo placed with red and green ink 2 weeks ago, and has noticed progressively worsening redness and pruritis developing, and a nonhealing wound with elements of the tattoo sloughing off. He denied fever, sore throat, nausea, vomiting, and shortness of breath, abdominal pain, hives and joint pain. The present discomfort is mild and somewhat pruritic. Scratching and pressure on site aggravate the area, and no relief was obtained with Keflex x 1 week.
The patient has not had similar symptoms in the past. There was no history of trauma prior to the placement of the tattoo.
The patient denies smoking, alcohol or drug abuse nor any past medical/surgical history or allergies.
On physical examination the patient was in moderate discomfort. His blood pressure was 151/51, pulse 90, respiratory rate 18, pulse oxygenation 98%, and temperature 97.2F. His pain scale was documented as 7/10.
The tattoo was a cartoon character located on his lateral left lower extremity wearing a hat and shirt in red dye ink, and other portions of the cartoon being in neon green ink. Erythema and mild edema were isolated to the borders of the tattoo and did not extend between the ink portions. The hat and shirt areas were open lesions, moist and tender with clear discharge. The areas with neon green ink was actively sloughing off and moist and tender. No fluctuance was noted.
What are your concerns as you examine this patient? Conclusion on next page