A case of tattoo-associated uveitis: JAMA
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A 26-year-old man presented for evaluation of blurry vision over the past year. He had no back or joint pain or skin rashes. Five years ago he had a black ink tattoo placed on his left arm, and 3 years ago a second tattoo was placed on his right arm. Two years after the right arm tattoo was placed, he noticed tattoo elevation on the left arm and onset of decreased vision.

He had recurrent episodes of ocular redness and blurred vision, coincident with inflammation of the skin surrounding both tattoos. Two months before presentation, bilateral peripheral iridotomies (iris laser procedures) were performed because of inflammation-induced adhesions between the iris and the lens.

At presentation, best corrected visual acuity was 20/20 in the right eye and 20/40 in the left. Intraocular pressure was 34 mm Hg in the right eye (upper limit of normal, 21 mm Hg) and 11 mm Hg in the left. On anterior segment slitlamp examination, there were no visible inflammatory cells in the anterior chamber of the right eye, but there were more than 26 cells per 1-mm field in the left.

The left arm tattoo was elevated, with nodular elevation most prominent at the superior aspect of the tattoo. Punch biopsy of the tattooed skin revealed epithelioid histiocytes with macrophages containing coarse black granular pigment.

Results of a systemic workup for infectious and inflammatory conditions were unremarkable, and the patient was started on topical prednisolone acetate eyedrops for treatment of ocular inflammation. The patient continued to have episodes of uveitis, even after prescription of adalimumab and methotrexate, requiring administration of short-acting intraocular steroids.

His vision worsened progressively over the subsequent 9 months until he had difficulty counting fingers at 0.3 m (1 ft) in each eye. The visual decline was attributed to cataract and persistent inflammation. He underwent bilateral fluocinolone acetonide implantation for improved long-term control, with concomitant cataract surgery 12 months after presentation. One month after surgery, best corrected visual acuity had improved to 20/300 in the right eye and 20/30 in the left, with improved intraocular inflammation.

Key takeaway:-
- The key to the correct diagnosis is the history of recurrent skin tattoo inflammation and concurrent ocular inflammation, with an otherwise negative workup for systemic infectious or inflammatory causes of bilateral uveitis.

- Results of the skin biopsy suggested that tattoo-associated uveitis was the most likely diagnosis.

Read more here: https://jamanetwork.com/journals/jama/fullarticle/2723634