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Trucian Adam Ostheimer, Bryn Burkholder, Theresa G Leung, Nicholas J Butler, James P Dunn, Jennifer E Thorne; Tattoo-Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2507.
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To describe the clinical presentation of bilateral uveitis with coincident onset of raised and indurated tattooed skin in a case series of six patients.
Six consecutive patients with coincident bilateral uveitis and cutaneous tattoo induration were evaluated at a tertiary ophthalmologic facility over the course of approximately one year. All subjects underwent complete ophthalmic examination and a focused systemic medical workup including serologic testing and imaging studies to rule out syphilis and sarcoidosis. Additional testing for specific uveitic etiologies was performed on a case-by-case basis. Two participants underwent biopsy of their tattoos. The patients’ clinical courses and responses to treatment over a follow-up period of one to twelve months are reported. Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results.
Patient ages at the time of presentation ranged from 20 to 42 years of age. Five patients are African-American and one patient is Caucasian. Initial best-corrected visual acuity varied from 20/20 to 20/400. Four patients were diagnosed with bilateral non-granulomatous anterior uveitis; three with chronic and one with recurrent disease. The remaining two patients were diagnosed with bilateral chronic granulomatous panuveitis. The most significant ocular complications included uveitic glaucoma, iris bombe, severe cystoid macular edema, and a neurosensory retinal detachment. All patients had multiple tattoos, some of which were multicolored, but only areas of skin containing black pigment were affected. Biopsies of raised and indurated tattoos were performed in two patients and demonstrated non-caseating granulomatous inflammation surrounding tattoo ink in the dermis. The skin changes resolved in all patients, with a faster response noted in those treated with high-dose oral prednisone for intraocular inflammation. Three patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos.
These cases may represent a subset of patients with previously undiagnosed sarcoidosis, in whom tattooing may have incited a simultaneous inflammation of the eyes and tattooed skin.
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