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Tattoo-associated uveitis is a rare but increasingly recognized form of uveitis. We describe a patient with severe tattoo-associated uveitis who underwent vitreous biopsy, revealing a T-lymphocyte infiltrate and cellular atypia.
An African American man in his mid-20s was referred for severe, chronic, bilateral, granulomatous panuveitis. His history was remarkable for extensive tattooing 5 to 6 years prior with subsequent induration at the tattoo margins and decreased vision within 6 months. He was seen by a dermatologist 4 years following tattooing. Skin biopsy at that time revealed noncaseating granulomas containing exogenous pigment (Figure 1A) and results were negative for acid-fast bacilli, fungi, and bacteria. He was diagnosed as having cutaneous sarcoidosis and was referred to a pulmonologist and rheumatologist. Investigations to support a diagnosis of sarcoidosis and evaluate for other causes of uveitis included angiotensin-converting enzyme, lysozyme, vitamin D levels, purified protein derivative, tuberculosis (by QuantiFERON-TB Gold testing), chest radiography, syphilis serologies, C-reactive protein, and erythrocyte sedimentation, all of which were normal. Combination immunosuppression led to resolution of skin changes, but the uveitis remained active.
Reddy AK, Shildkrot Y, Newman SA, Thorne JE. T-Lymphocyte Predominance and Cellular Atypia in Tattoo-Associated Uveitis. JAMA Ophthalmol. 2015;133(11):1356-1357. doi:10.1001/jamaophthalmol.2015.3354