TAGU D86.3

The acronym TAGU stands for "tattoo-associated granulomas with uveitis" and refers to a rare, bilateral intraocular inflammation and concomitant development of sarcoid skin reactions in tattoo areas (Carvajal Bedoya G et al. 2020).

Granulomatous tattoo reaction with concomitant uveitis is a rare clinical entity and is likely underdiagnosed. It should be considered in all patients who have uveitis of unclear cause (Carvajal Bedoya G et al 2020). Epidemiologic data are not available.

The pathology of the granulomatous tattoo reaction associated with uveitis is not well known so far. A delayed hypersensitivity reaction to the antigens in the tattoo ink is discussed (Kluger N 2018). The high antigenic continuous exposure could trigger this condition in susceptible individuals.

A second hypothesis assumes chronic mild antigenic stimulation by tattoo ink, leading to a systemic granulomatous reaction consistent with sarcoidosis in predisposed individuals (Sepehri M et al 2016)

Patients who experience TAGU without concurrent sarcoidosis tend to be younger and more likely to have used black ink for tattooing. Uveitis occurs almost concurrently with the tattoo reaction, and symptoms appear within the first year after tattooing.

TAGU usually responds to immunosuppression or removal of the tattoo (Ostheimer TA et al. 2014).

Granulomatous tattoo reaction with accompanying uveitis may manifest with or without signs of systemic sarcoidosis and usually responds to immunosuppression and/or removal of the tattoo (if possible).

Tattoos have now become a mass phenomenon. Surveys in several countries found that the prevalence of tattoos in the general population is about 24% (Carvajal Bedoya G et al. 2020). The occurrence of side effects is rather rarely reported. A not inconsiderable number of unreported cases can be assumed.

A 32-year-old Caucasian male noticed bilateral eye redness with blurred vision for several months. On examination of the system, a concurrent appearance of an areal red, tender, and at times itchy swelling in a large black tattoo on the right arm and chest was noticed. This tattoo was pricked 1 year before presentation. 2 older tattoos were not affected.

The patient was initially treated with topical ocular glucocorticoids without significant improvement. He then required oral methylprednisolone 24 mg daily, which was reduced to 4 mg daily over 6 days. This agent resulted in rapid resolution of inflammatory swelling in the tatoo area, but not macular and papilledema. Adalimumab at a dosage of 40 mg subcutaneously every two weeks resulted in satisfactory resolution of all of his symptoms.

1. Carvajal Bedoya G et al (2020) Tattoo Granulomas With Uveitis. J Investig Med High Impact Case Rep 8:2324709620975968.
2. Kluger N (2018) Tattoo-associated uveitis with or without systemic sarcoidosis: a comparative review of the literature. J Eur Acad Dermatol Venereol 32:1852-1861.
3. Kluger N (2018) Tattoo-associated uveitis with or without systemic sarcoidosis: a comparative review of the literature. J Eur Acad Dermatol Venereol 32:1852-1861.
4. Ostheimer TA et al (2014) Tattoo-associated uveitis. Am J Ophthalmol 158:637-643.e1.Wenzel S et al. (201e3) Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology. 226:138-147.
5. Sepehri M et al. (2016) Papulo-nodular reactions in black tattoos as markers of sarcoidosis; study of 92 tattoo reactions from a hospital material. Dermatology 232:679-686.
6. Wenzel S et al. (201e3) Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology. 226:138-147.