Abstract
Bilateral intraocular inflammation and simultaneous development of tattoo granulomas has been described in several case reports. The pathophysiology of this process is poorly understood, and it has been hypothesized that it could be a similar mechanism to systemic sarcoidosis versus a delayed hypersensitivity response. Granulomatous tattoo reaction with associated uveitis can manifest with or without evidence of systemic sarcoidosis, and it is usually responsive to immunosuppression and/or tattoo removal. We present a patient with no prior diagnosis of sarcoidosis who developed bilateral panuveitis and tattoo changes suggestive of tattoo granulomas with uveitis (TAGU). The patient was initially managed with intraocular steroids and systemic steroids with minimal improvement of symptoms. The patient later required steroid sparing therapy with a tumor factor inhibitor to achieve remission. There is a growing prevalence of tattooing among the general population and a low reported rate of tattooing complications. Granulomatous tattoo reaction with associated uveitis should be a consideration in patients with tattoos presenting with “idiopathic” uveitis.
Highlights
Surveys across multiple countries revealed that the prevalence of tattoos in the general population is approximately 24%
We report the case of a young adult who developed a granulomatous reaction after the application of a large tattoo
A second hypothesis proposes a chronic mild antigenic stimulation from the tattoo ink leading to systemic granulomatous reaction consistent with sarcoidosis in susceptible individuals.[4]
Summary
Surveys across multiple countries revealed that the prevalence of tattoos in the general population is approximately 24%. Skin examination was significant for inflammation, induration, and scant desquamation in a pattern that closely matched the borders of the tattoo. Review of systems was notable for simultaneous onset of diffuse erythema, tenderness, induration, and pruritus of a large black ink tattoo over the right arm and chest (Figure 1). This tattoo was inked 1 year prior to presentation. Histological examination revealed granulomatous inflammation with associated tattoo ink deposition consistent with foreign body-type granulomatous reaction (Figure 4). The patient was initially treated with topical ocular glucocorticoids without significant improvement He required oral methylprednisolone 24 mg daily, tapered to 4 mg daily over 6 days. A follow-up examination 4 months later revealed minimal, if any, subtle inflammation in both eyes, mild worsening of the macular edema in his left eye, and visual acuity of 20/20 by Snellen chart
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