Uveitis associated with tattoo granulomas

Ocular symptoms are a common reason for patients to present to the emergency department or to their primary care physician. Though often benign, these symptoms can also be an early manifestation of systemic disease. We report the case of a patient who presented to the emergency department with 1 week of rash followed by 2 days of fever, sore throat, chills, blurry vision and photophobia. His physical examination was notable for a desquamative rash over his tattoos, left-sided tonsillar exudate and pharyngeal oedema without lymphadenopathy. Biopsy of his tattoos revealed subepithelial non-caseating granulomas, confirming the diagnosis of tattoo granulomas with uveitis. The patient was started on corticosteroids and methotrexate and responded well to treatment. This case emphasises the importance of recognising ocular symptoms that are indicative of systemic disease and require further evaluation.