First Author: M.Johnson UK
Co Author(s): J. Vallance 0 0 0 0 0 0 0 0 0
Back to previous
To describe the clinical features of 3 patients presenting with simultaneous uveitis and tattoo inflammation.
Tertiary referral uveitis clinic, Ninewells Hospital, Dundee, Scotland
Retrospective case note review.
Case 1; 20 year old female presented with localised skin inflammation affecting all of her tattoos. Simultaneously developed bi-lateral acute anterior uveitis and left anterior scleritis. Investigations revealed a raised serum angiotensin-converting enzyme (ACE) of 148 (17-85) and tattoo biopsy showed a granulomatous reaction related to tattoo pigment. Both skin and eye signs improved on systemic immunosuppression. Case 2; 23 year old male with severe bi-lateral acute anterior uveitis and ‘lumpy’ tattoos. Tattoo biopsy showed granulomatous ‘sarcoid type’ reaction in association with tattoo pigment. Serum ACE, chest x-ray and other uveitis investigations were normal. Although high dose prednisolone resolved the tattoo inflammation, he developed a bi-lateral panuveitis including, retinal neovascularisation and secondary left posterior sub-capsular cataract. Pan-retinal photocoagulation was performed and ocular inflammation has remained stable on infliximab. Case 3; 40 year old male developed tattoo inflammation and right panuveitis with cystoid macular oedema and left acute anterior uveitis. Serum ACE was raised at 152 and CT chest was normal. Sarcoid granulomatous inflammation was reported on tattoo biopsy. His eye inflammation completely resolved with a short course of oral prednisolone. He remains on hydroxychloroquine and topical tacrolimus for cutaneous sarcoidosis.
Uveitis in association with tattoo inflammation can have a variable presentation. This case series reinforces the high index of suspicion for sarcoidosis, supported by appropriate investigations including tattoo biopsy. However, uveitis secondary to tattoo pigment is also an important differential as illustrated in case 2. Clinicians need to be alert to this as the number of patients with tattoos is likely to increase. Management must be guided by systemic involvement as well as response to treatment and any secondary vision threatening complications.