Tattoo-Associated Uveitis: An African Case Series

Purpose: Tattoo-associated uveitis is a rare condition often linked to sarcoidosis. Its presentation in African individuals has not been previously documented, and, in the cases we report, it exhibited an unusual pattern characterized by the absence of evident systemic involvement. Methods: We report three cases of Ethiopian patients with tattoo-associated uveitis. None of the patients showed signs of sarcoidosis on chest X-ray or clinical examination, although systemic sarcoidosis was not completely ruled out by biopsy or chest CT. The absence of chest CT or biopsy represents a limitation of this study, due to resource constraints. All developed inflammatory skin reactions in their black-ink tattoos, followed by ocular inflammation. Uveitis resolved with systemic corticosteroid therapy in all cases, with only one patient experiencing a relapse requiring methotrexate. Results: Unlike previous reports primarily involving African American patients, this series highlights the presence of tattoo-associated uveitis in African individuals without clinical or radiographic evidence of systemic sarcoidosis. Black tattoo pigments appeared to be a common factor, potentially triggering localized immune responses that may extend to ocular structures. Conclusion: This case series expands the clinical spectrum of tattoo-associated uveitis beyond its usual association with sarcoidosis. In these African patients, no systemic involvement was evident during evaluation. Clinicians should consider tattoo inspection in unexplained uveitis, including non- granulomatous cases, which were also observed in our series.