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Abstract: Tattoo reactions have become more common as tattoos gain visibility and popularity worldwide. A variety of inflammatory patterns have been described in association with tattoos- more commonly fibrosing, granulomatous, lichenoid, pseudolymphomatous, and spongiotic patterns. To date, there has been one case report of a Wells syndrome-like inflammatory pattern associated with a temporary Henna tattoo. Here we present the first case of a permanent tattoo with resulting flame figures, histologically resembling Wells syndrome. We believe this uncommon histologic pattern might be of interest for pathologists to be aware of., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A 45-year-old white woman presented with fever, arthalgias, and widespread erythematous papules after a recent Parvovirus B19 infection. Biopsy findings were consistent with classic Sweet syndrome. A splenectomy, which was performed due to radiographic evidence of multiple splenic lesions, revealed a diffuse neutrophil-predominant infiltrate with formation of numerous "abcesses." Her skin lesions recurred several times over the next 6 years, with repeat biopsies showing evidence of recurrent Sweet neutrophilic dermatosis. The initial and recurrent skin eruptions were responsive to systemic steroids. A paratracheal lymph node biopsy was later performed to evaluate widespread lymphadenopathy, which showed complete effacement of nodal architecture by a mixed inflammatory and fibrotic process including neutrophils, with features reminiscent of cat-scratch disease. Special stains, tissue culture studies, and serologies were negative for an infectious etiology, and an extensive evaluation for hematologic or other malignancy was negative. This clinical-pathologic presentation was consistent with Sweet syndrome involving both cutaneous and lymphoreticular (spleen and lymph nodes) sites. This case illustrates the importance of recognizing extracutaneous involvement in Sweet syndrome and differentiating this from infectious, malignant, and other processes. The literature on extracutaneous involvement of Sweet syndrome is reviewed.

Lobular capillary hemangioma (pyogenic granuloma) is a common vascular proliferation that typically occurs in the superficial dermis, although rarely a subcutaneous form has been reported. Although these lesions are considered benign, localized recurrence after excision and satellite spread of the lesions are known phenomena. A case of lobular capillary hemangioma with the unusual features of both subcutaneous localization and locally aggressive behavior following surgery in a patient with a history of estrogen use and local trauma prior to the onset of the lesion is presented. The literature of lobular capillary hemangioma is reviewed, and the differential diagnosis is discussed.