title: Tattoo-associated uveitis.
abstract: OBJECTIVE
  To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Seven consecutive patients were evaluated at a tertiary ophthalmologic facility with coincident uveitis and cutaneous tattoo induration over an 18-month period. All subjects underwent complete ophthalmic examination and a focused systemic medical evaluation including serologic testing and imaging studies. Two participants underwent biopsy of their tattoos. The patients' clinical courses and responses to treatment over a follow-up period of 1-20 months are reported (mean follow-up = 9 months). Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results.
  
  
  RESULTS
  Five of 7 patients had bilateral nongranulomatous anterior uveitis: 4 with chronic and 1 with recurrent disease. The remaining 2 patients had bilateral chronic granulomatous panuveitis. Biopsies of raised and indurated tattoos were performed in 2 patients and demonstrated noncaseating 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. Five patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos.
  
  
  CONCLUSIONS
  These cases represent a subset of patients in whom skin tattooing may have incited an immune response leading to simultaneous inflammation of the eyes and tattooed skin.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tosthei1@jhmi.edu.
authors.forename: Trucian A
authors.initials: TA
authors.lastname: Ostheimer
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bryn M
authors.initials: BM
authors.lastname: Burkholder
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Theresa G
authors.initials: TG
authors.lastname: Leung
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Butler
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005446:Fluocinolone Acetonide / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012867:Skin / Q000187:drug effects / Q000473:pathology; D013653:Tattooing / Q000009:adverse effects*; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D005446:Fluocinolone Acetonide