HPI: A 26 year-old Caucasian male presented with a one year history of bilateral anterior uveitis. This occurred in conjunction with inflammation of two exclusively black ink tattoos located on his upper arms bilaterally. There were no signs of ocular inflammation immediately on tattoo placement. However, 6 months after placement of the second tattoo. he noted recurrent flares of uveitis. The flares were associated with induration of his tattoos. He was then evaluated by ophthalmology and placed on high dose oral prednisone and intraocular steroid injections. Labs were negative for infectious etiologies and systemic sarcoidosis. He was referred to dermatology for further evaluation and biopsy.
Social Hx: Married, non-smoker, denied alcohol use and denied illicit drug use. No recent travel history.
Family Hx: No significant family history.
Allergies: No known drug allergies.
Acetazolamide; Brimonidine/Timolo; Dorzolamide; Humira; Prednisolone; Combigen: Intraocular Triamcinolone.
CBC, RPR, CXR, ACE, IFN gamma were normal
Physical Exam: Black ink tattoos were present on the bilateral upper arms. Papular induration limited only to black ink areas. There is uniform papular induration exclusively involving only the skin injected with black ink (Figs.1-2) There is no involvement of normal skin (Fig.3) Bilateral ocular inflammation noted.
Click here for the Diagnosis.