Cutaneous granuloma and uveitis caused by a tattoo

Abstract

A 24-year-old male with red tattoos developed ocular pain and blurred vision three years after having been tattooed. The patient also noticed redness and itching in the area of the tattooed skin (Fig. 1). The rest of the history and physical examination was unremarkable. Routine laboratory screening tests were within normal limits, with the exception of a mildly elevated white blood cell count (11,6 G/L). Chest X-ray examination and CT scan were within normal limits. Ophthalmological examination revealed panuveitis of the right eye with keratic precipitates, several firm posterior synechiae, infiltrated vitreous, and acute iridocyclitis of the left eye with ciliary congestion, flare and cells in the anterior chamber, and keratic precipitates (Figs. 2, 3). Histological examination of the lesion confirmed granulomatous reaction in the tattooed skin. Excision of the inflamed tattoo, administration of topical and systemic steroid (40 mg/day of prednisolone orally and 0,5% prednisolone acetate eye drops (2 drops twice daily) and cyclosporin (150 mg/day orally for 4 weeks) resulted in remarkable improvement in visual acuity and cure of the uveitis. All medications were discontinued, and the patient has been asymptomatic since. To our knowledge, the coexistence of uveitis and tattoo granulomas has only been reported once in the English language medical literature by Rorsman et al. [1]. According to their suggestion, tattoo granulomas and uveitis may be a special granulomatous hypersensitivity syndrome induced by cobalt [1]. As with their three cases, our patient also had no signs of systemic sarcoidosis and developed the ophthalmologic symptoms delayed after having had his skin tattooed.

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

“…We selected 27 articles, published between 1952 and 2018, for a total of 39 patients . We considered three distinct groups separately: (i) sarcoidosis on permanent tattoos associated with uveitis and systemic involvement or cutaneous sarcoids outside of tattoos; (ii) granulomatous tattoo reactions associated with uveitis without evidence for systemic sarcoidosis; and we also included here (iii) exceptional cases of uveitis after tattooing, without any granulomatous reaction on tattoos nor systemic sarcoidosis . Only three series were dedicated to tattoo‐associated uveitis: seven cases from USA, three cases from Sweden and two cases from Czech Republic .…”

“…In 2013, we had reviewed eight cases of uveitis after tattooing, seven cases of which were associated with tattoo granulomas . Since then, we found in the literature 15 additional cases .…”

Severe adverse events related to tattooing: An retrospective analysis of 11 years

“…[1011] Sometimes, they can cause more severe problems like uveitis, disseminated granulomatous reactions or perforating granulomatous reaction. [12–14] We observed long-term problems with edema formation or erythema nodosum development. [5] Laser treatment in such cases may increase the risk of further adverse effects.…”

Tattoo-associated uveitis

“…1 Similar cases of uveitis associated with tattoos have been described and in three cases the uveitis resolved after tattoo excision. [1][2][3] All cases initially required systemic immunosuppression to control the uveitis.…”