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• W2051250994 abstract "Editor, Tattoo granulomas can be a manifestation of sarcoidosis but may also be a delayed hypersensitivity reaction to pigment containing metallic tattoo compounds. The association of recurrent anterior uveitis with swelling of skin tattoos is an unusual occurrence. We report the case of a 28-year-old woman who presented with pain, photophobia and redness in both eyes. Initial presentation was asymmetric, as the symptoms were more pronounced in the right eye. Simultaneously, a rash on the site of the skin tattoos had developed. The patient had extensive tattoos on her chest, back and around the umbilicus; she received the tattoos between 13 years and 1 year prior to her presentation (Fig. 1A). (A) The patient’s tattoo. (B) T-lymphocytes and macrophages around pigment. (C) Granulomatous response (circles) and tattoo pigment (arrow). (D) Fibrin deposit. Best corrected visual acuity was 20/20 in both eyes. Slit-lamp examination revealed severe ciliary congestion and 2+ flare and 2+ cells, based on the SUN-classification (Standardization of Uveitis Nomenclature), in the anterior chamber. The clinical signs were more pronounced in the right eye fundoscopy was bilaterally normal. The skin tattoos were swollen and slightly raised. Palpation demonstrated clinical granulomatous characteristics. Investigations for the possible causes of the anterior uveitis, including serologic testing (complete blood count, renal function, liver function, angiotensin-converting enzyme, human leucocyte antigen-B27, antinuclear antibody, rheumatoid factor and infectious parameters) and chest X-ray were all normal. Clinical pneumological examination, thoracic computed tomography and abdominal ultrasound showed no evidence of sarcoidosis. A tattoo biopsy showed a granulomatous response characterized by lymphocytes and histiocytes around the tattoo pigments (Fig. 1B,C); there was no histological evidence of sarcoidosis. The anterior uveitis resolved with topical steroid drops and ointment, and the tattoo swelling decreased with steroid skin ointment. Six weeks after the steroids were tapered, the uveitis and tattoo swelling recurred. The patient’s right eye showed 2+ cells and 2+ flare in the anterior chamber; the left eye showed fibrin deposits (Fig. 1D), and a posterior synechia was detected. Topical treatment with steroids and dilating agents was restarted and proved to be effective. Similar cases of uveitis associated with tattoo inflammation have been reported in the literature (Rorsman et al. 1969; Mansour & Chan 1991; Mc Elvanney & Sherriff 1994; Barabasi et al. 2008; Salabi et al. 2010). In four of the seven cases, the uveitis resolved after tattoo excision. Five of the seven cases initially required systemic immunosuppression with steroids, azathioprine or cyclosporine. The presence of tattoo pigment in granulomas suggests that these metallic compounds are able to cause a sensitization reaction (Mansour & Chan 1991). Delayed hypersensitivity reaction to tattoos can occur in the histological form of sarcoidal granuloma (Mansour & Chan 1991). In this case, the tattoo inflammation mirrors the ocular inflammation. Sarcoidosis could be the underlying aetiology, but there were no clinical, laboratory or radiological features of sarcoidosis. Extensive foreign body tattoo pigments, as present in this patient, could have contributed to the activation of the lymphocytes (Salabi et al. 2010). Rorsman et al. (1969) suggested that allergens, which are slowly absorbed from the inflamed tattoo, may accumulate in the uvea and induce and maintain the eye disease. Excision was not an option in the present patient because the tattoos were very extensive. This case demonstrates a rather unusual association between recurrent anterior uveitis and skin induration at the site of tattoos. It shows that tattooassociated uveitis can occur without evidence of sarcoidosis. Treatment approaches should be based on standard therapy for noninfectious uveitis, and in the case of uncontrollable recurrent uveitis, systemic immunosuppression therapy should be considered. The condition of the tattoos can assist with monitoring the treatment." @default.
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• W2051250994 date "2013-07-02" @default.
• W2051250994 modified "2023-09-27" @default.
• W2051250994 title "Skin tattoos and the development of uveitis" @default.
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• W2051250994 doi "https://doi.org/10.1111/aos.12216" @default.
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