Infective endocarditis presenting with Parinaud's dorsal midbrain syndrome

Complication of nasal piercing by Staphylococcus aureus endocarditis: a case report and a review of literature

Body piercing, a growing trend especially in young people, is often complicated by severe infections. We present a case of acute bacterial endocarditis by Staphylococcus aureus complicated by multiple cerebral, kidney, spleen embolisms in a young girl, with no known previous cardiac abnormalities, following the piercing of nasal septum. This case highlights the importance of education of patients with and without structural heart disease to the potential dangerous and even life threatening infectious complications of piercing, and stimulate further discussion on the possibility of antibiotic prophylaxis of such procedures.

Infective endocarditis after body art: a review of the literature and concerns

PURPOSE

Infective endocarditis (IE) is a rare but dangerous complication of tattooing and body piercing in adolescents and young adults 15-30 years of age, with and without congenital heart disease (CHD). Because body art, including tattooing and piercing, is increasing and IE cases continue to be reported in the literature, a longitudinal assessment of IE and body art cases is important to examine for trends.

METHODS

A 22-year (1985-2007) longitudinal electronic Medline and Scopus review of all published cases of IE and body art was conducted.

RESULTS

In all, 22 specific cases of IE spanning 1991-2007 have been reported that were associated with piercing the tongue (seven), ear lobes (six), navel (five), lip (one), nose (one), and nipple (one), and reported in one heavily tattooed person; other general IE cases have also been mentioned. Twelve cases were in females, and one patient died; nine of these individuals had CHD. Twenty-one cases have been published in the 10 years from 1997-2007.

CONCLUSIONS

Although there is no denominator to assess the real risk, this review provides more evidence of IE and body art concerns, and should stimulate further discussion regarding IE antibiotic prophylaxis. It is believed that IE is triggered by normal flora at the body art site, microorganism colonization around the jewelry, or by a localized site infection that stimulates episodes of transient bacteremia (commonly caused by staphylococi) and then seeds various areas of the heart. Frequently in such cases the mitral or aortic valves need to be replaced. For individuals with CHD who want body art, prophylactic antibiotic regimens have been suggested since 1999. Millions of tattoos and body piercings are done yearly, and more IE cases are therefore suspected. An international electronic repository of body art complications would provide better documentation. Body art procurement for many persons in this age group is a matter of "when, not if"; thus proactive, frequent, targeted educational strategies for adolescents and artists practicing body art are suggested.

The hole picture: risks, decision making, purpose, regulations, and the future of body piercing

Can it be said that body piercing is ubiquitous, found across all socioeconomic groups? The major concentration is among adolescents and young adults 15 to 30 years old, in some studies, 50% of the population. Commonly identified physical risks are bleeding, tissue trauma, and bacterial infections; psychosocial risks are unhappiness, low self-esteem, and disappointment. The Health Belief Model is used to explain decision making; purposes for body piercing consistently center on personal expression (self-identity) and uniqueness. The international and US body piercing regulations are discussed, leading to the need for tracking complications globally and standardization of regulations. Proactive health education for clients and health providers remains a priority.