CA2 Hacek endocarditis and tongue piercing. (Cardiology).

CA2 HACEK ENDOGARDITIS AND TONGUE PIERCING. Hossein Akhondi, MD, and Ali R. Rahimi, MD. Department of Internal Medicine Education, Memorial Health University Medical Center, Savannah, Ga.

Body piercing is an increasingly common practice in the United States. This practice carries a substantial risk of morbidity and is mostly done by unlicensed and unregulated individuals. A group of micro-organisms collectively called HACEK cause endocarditis, more often in individuals with structural heart diseases. There might be a cause and effect relation between tongue piercing and HACEK endocarditis. A 25-year-old white man with a history of congenital aortic valve stenosis, surgically corrected at age 8, presented with fever and worsening of his diastolic murmur. His blood culture was positive for Hemophilus aphrophilus, a member of the ACEK family. Transesophageal echocardiography showed vegetation of aortic valve. Two months earlier, the patient had added a tongue stud to his preexisting extensive tattoos. The invasive application of ornaments through cutaneous and mucosal surfaces enables the penetration of various pathogens into subcutaneous tissues. In another study, the investigators described a c ase of endocarditis after nasal piercing. Hemophilus aphrophilus is part of the normal flora of oral cavity and has the potential to become virulent. We believe that after tongue piercing this organism colonized and acted as a seeding source for bacteremia and aortic valve endocarditis. It is important to establish educational programs to emphasize the potential hazards of body art practices in this patient population. Antibiotic prophylaxis should be a consideration if these individuals decided to undergo piercing.