We report a case of panuveitis and macular oedema associated with tattoo inflammation. The course of uveitis, which has responded to systemic immunosuppression, has followed the course of tattoo inflammation.
A 49-year-old man with known asthma, psoriasis and hypertension presented with bilateral reduced vision and floaters. Systematic enquiry revealed a chronic cough and tattoo swelling.
Visual acuities were 6/9 in the right eye and 6/18 in the left eye. Examination revealed severe bilateral panuveitis, multiple mid-peripheral atrophic punched-out fundal lesions, and bilateral cystoid macular oedema. His tattoos were swollen and raised (Figure 1a). Investigations for causes of uveitis, including serum ACE, chest X-ray, and CT scan were normal. A tattoo biopsy revealed a florid granulomatous response around the included tattoo pigment (Figure 1b).
The uveitis and macular oedema resolved with oral prednisolone 75 mg OD, which also reduced the tattoo swelling. Vision improved to 6/6 bilaterally. After 4 months, following steroid tapering, his uveitis recurred and azathioprine was started. Systemic immunosuppression with prednisolone and azathioprine has controlled the uveitis to date.