Case report

A 41-year-old man was evaluated in the emergency room for symptoms suggesting an infective or inflammatory central nervous system (CNS) lesion. He needed cerebrospinal fluid (CSF) analysis as part of the initial diagnostic process. However, he had a 5-year-old, well-healed, multicoloured lumbar tattoo covering the entire skin surface of his back. We therefore performed a lumbar puncture using a technique to avoid contact between the spinal needle and the pigmented dermis and epidermis (figure 1). We first anaesthetised the subcutaneous and muscular layers with 4 mL of 2% mepivacaine. We then inserted an 18 gauge×51 mm Abbocath catheter along the same trajectory of a usual lumbar puncture in L3–L4 space, which overpasses the pigmented skin but does not reach the dural plane. Finally, we passed through the …