Granulomatous Panuveitis Associated with Body Piercing

To report a case of bilateral granulomatous panuveitis temporally associated with a body piercing and to highlight a potential immune-mediated mechanism analogous to tattoo-associated uveitis.

This case included comprehensive clinical evaluation, multimodal ophthalmic imaging, and laboratory testing for infectious and systemic autoimmune disease. Treatments included corticosteroids and immunomodulatory therapy.

A 16-year-old female with no past medical or ocular history and no history of tattoos developed progressive bilateral vision loss shortly after navel piercing placement. Her visual acuity was 20/200 in the right eye and hand motion in the left eye. Examination revealed granulomatous keratic precipitates, posterior synechiae, cataracts, vitritis, and disc edema, consistent with bilateral granulomatous panuveitis. Optical coherence tomography revealed diffuse intraretinal fluid, subretinal fluid, and bacillary detachment with a thick choroid. Fluorescein angiography showed disc leakage, macular leakage, and diffuse perivascular leakage. Intermediate-late-phase indocyanine green angiography demonstrated patchy hypofluorescent dark dots. Extensive infectious and systemic autoimmune work-up was negative. Her review of systems was negative. The patient achieved marked improvement and durable inflammation control with high doses of corticosteroids, methotrexate, and infliximab.

We describe a case of bilateral granulomatous panuveitis temporally associated with a body piercing; however, causality cannot be established, and the proposed mechanism remains hypothesis-generating. Metal-specific delayed-type hypersensitivity or foreign body granulomatous inflammation, also implicated in tattoo-associated granulomatous uveitis, represents a plausible mechanism. Clinicians should inquire about recent tattoos or piercings when evaluating bilateral granulomatous uveitis of unclear origin, as early recognition and appropriate immunomodulatory therapy may prevent vision loss and morbidity.