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Research Letter
November 2015

T-Lymphocyte Predominance and Cellular Atypia in Tattoo-Associated Uveitis

Author Affiliations
  • 1Department of Ophthalmology, University of Virginia, Charlottesville
  • 2Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2015;133(11):1356-1357. doi:10.1001/jamaophthalmol.2015.3354

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.

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