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Am Fam Physician. 2003;67(8):1804

Piercing of various sites of the body (other than the ear lobe) is increasing in popularity and has been reported in children as young as 11 years. Noninfectious complications of body piercing include prolonged bleeding and keloid formation. Infectious complications can include transmission of blood-borne infections, including human immunodeficiency virus and hepatitis B, C, and D, as well as bacteremia through the site of the piercing. Staphylococcus aureus is the most common organism transmitted through skin infections. Septic arthritis and acute glomerulonephritis have occurred following ear piercing, and infectious endocarditis has been reported after body piercing. Weinberg and Blackwood report the first documented case of bacterial endocarditis following navel piercing.

A 13-year-old girl who underwent cardiac surgery at age three years for transposition of the great arteries and who had been in good health presented with a low-grade fever, nausea, vomiting, and abdominal pain. One month earlier, the patient had pierced her own navel at home with a sewing needle after cleaning the area with rubbing alcohol. Two days after the piercing, the area looked infected, but the infection gradually resolved after the navel ring was removed.

The patient was admitted to the pediatric intensive care unit because of lethargy and confusion. A systolic murmur was audible, and the abdomen was diffusely tender, with rebound but no guarding. Hepatomegaly without splenomegaly was present. Echocardiography revealed a thin, mobile mass at the level of the pulmonary valve that prolapsed through the valve during diastole. Blood cultures grew S. aureus, and the patient was given appropriate antibiotic therapy. After a difficult hospital course, she was sent home on long-term antibiotic therapy.

Antibiotic prophylaxis is recommended by the American Heart Association to prevent bacterial endocarditis in certain persons with heart disease after some oral surgical procedures; however, surgical incisions require nothing more than routine surgical scrubbing procedures. Most body piercings, however, occur in a less controlled environment where infection is more likely to occur.

The authors conclude that although there are no specific recommendations for it, persons with congenital heart disease should be counseled about the risk of endocarditis, as well as other potential complications, resulting from body piercing. Because of the low price of single-dose prophylaxis and the ease of administration, it also would be prudent to provide antibiotic prophylaxis to patients with congenital heart disease who decide to undergo body piercing, until more data are obtained regarding the need and efficacy of prophylaxis.

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