Sarcoid Uveitis: A Look Beyond The Eyes

Bilateral acute uveitis can cause significant morbidity, and a complete workup is often warranted. This report illustrates a case of sarcoid uveitis definitively diagnosed by skin biopsy in a patient with red tattoo ink.

A 40-year-old African American male presented with bilateral photophobia and intraocular pressures of 26 mmHg in both eyes, 1+ grade cell and flare in both eyes, and granulomatous (mutton fat) keratic precipitates in both eyes. Serum angiotensin-converting enzyme level was elevated at 146 U/mL (normal value <40 U/mL), and computed tomography imaging revealed mediastinal and hilar lymphadenopathy. Multifocal induration and elevation in the areas of red pigment of a tattoo were also present and on punch biopsy revealed noncaseating granulomas, confirming the diagnosis of sarcoid uveitis.

Our case suggests that a complete physical examination and inquiry about the presence of any tattoos should be conducted as part of the workup of uveitis.