Papules and nodules on scars

Abstract

55-year-old female patient, with a medical history of obesity, former smoker, COVID-19 infection in mid-April 2021, bilateral carpal tunnel surgery in 2011 and gastric sleeve in 2014. She consulted on May 13, 2021 due to injuries of Spontaneous appearance on tattoos and all post-surgical scars. On physical examination, there were multiple hard-elastic papules measuring 3 mm in diameter that were located on tattoos made more than 10 years ago, in all their colors, some isolated and others agminated, forming plaques that partially or completely covered said tattoos. She also associated normal skin-colored nodules under 12-day-old surgical scars. A punch biopsy was taken from one of the nodular lesions and a complete laboratory was requested.

On June 2, 2021, the patient began follow-up by the Pulmonology Service for post-COVID-19 dyspnea. They requested a chest tomography where the presence of mediastinal lymph nodes and a bilateral nodular pattern predominantly in the middle and upper lobes were noted.

In the blood laboratory, increased values of ESR (26 mm), CRP (1.16 g/dL) and angiotensin converting enzyme (ACE) of 171 µg/L were obtained. The rest were within normal parameters.

The histopathological analysis reported, in the deep reticular dermis and hypodermis, non-caseating granulomas made up of epithelioid histiocytes with multinucleated giant cells, with little surrounding lymphocytic inflammation.