Doctors noted the connection when a woman started to suffer from chronic pain in her left hip, knee and thigh a few months after she had had a tattoo.
She'd had tattoos on her right-side years earlier without any ill effects, but in the intervening years she had been taking drugs to dampen down her immune system responses after having had a double lung transplant.
The pain after the second tattoo was so great that she eventually had to take powerful painkillers. Doctors hadn't worked out that the tattoo was the cause of her problems at the time and referred her to a rheumatology clinic.
A biopsy of her thigh muscle eventually discovered she had inflammatory myopathy, or chronic muscle inflammation, with symptoms including muscle weakness and pain.
Although the cause of myopathy is often mysterious and can happen spontaneously, the doctors believe in this case it was caused by the tattoo which she had when the immune system was already compromised.
The type of ink and colourants used in tattooing can cause reactions from mild skin irritation to systemic infection, but problems become much more likely if the immune system is not healthy.
"The tattoo industry has no regulated or professional body to enhance standards," the doctors say in a case study report, "and in this case the tattoo application by an unregulated parlour, combined with the patient's immune suppression, could have resulted in the adverse reaction."