Endgames

A 34 year old man with bilateral anterior uveitis and a rash

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6831 (Published 31 October 2011) Cite this as: BMJ 2011;343:d6831
  1. Anish N Bhuva, foundation year 1, respiratory medicine1,
  2. Harpreet K Lota, specialty trainee year 3, respiratory medicine1
  1. 1Hillingdon Hospital NHS Foundation Trust, Uxbridge UB8 3NN, UK
  1. Correspondence to: H K Lota harpreet.lota{at}hotmail.co.uk

A 34 year old railway engineer of south Indian descent was under the care of the ophthalmology team. He was being treated for bilateral anterior uveitis with topical steroids and mydriatics after a one month history of decreasing visual acuity, photophobia, and ocular pain. He also had a four month history of irritation over his tattoo sites that his general practitioner had suspected was dermatitis related to ultraviolet radiation. He was also having severe night sweats. In view of these symptoms, he was referred to the medical team.

His medical history included well controlled asthma and two hospital admissions for lower respiratory tract infections in the past five years. He had no known allergies and the only drug that he took regularly was budesonide/formoterol 200/6. He was an ex-smoker, having stopped two months previously.

On admission, his observations were normal. Abnormalities over his tattoo sites were noted (fig 1) and his visual acuity was reduced to 6/18 bilaterally. All other systems examinations were normal. Full blood count, electrolytes, liver function tests, and bone profile tests were within normal ranges. C reactive protein was 13 mg/L (reference range 0-5) and his erythrocyte sedimentation rate was 14 mm in the first hour (0-10). Autoimmune serologies, VDRL, and HLA B27 were negative. Serum angiotensin converting enzyme was 154 mg/L (20-90). A chest radiograph was performed (fig 2).

Fig 1 Abnormalities over the patient’s tattoo sites

Fig 2 Chest radiograph

Questions

  • 1 What abnormalities can be seen in the figures?

  • 2 What is the likely diagnosis?

  • 3 How else does this condition present?

  • 4 How would you manage a patient with this condition?

Answers

1 What abnormalities can be seen in the figures?

Short answer

The tattoo has a raised indurated appearance over the surface of the pigment (fig 3). The chest radiograph shows bilateral hilar lymphadenopathy (fig 4).

Fig 3 Induration …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe