Academic journal article Canadian Journal of Public Health

Pseudomonas Aeruginosa Necrotizing Chondritis Complicating High Helical Ear Piercing Case Report: Clinical and Public Health Perspectives

Academic journal article Canadian Journal of Public Health

Pseudomonas Aeruginosa Necrotizing Chondritis Complicating High Helical Ear Piercing Case Report: Clinical and Public Health Perspectives

Article excerpt

ABSTRACT

Background: Auricular or high helical ear piercing is an increasingly widespread fashion trend that is associated with an increased risk of potentially serious post-piercing complications such as auricular perichondritis.

Case report: An 11-year-old girl developed severe auricular perichondritis following piercing of the upper helical cartilage of her ear at a hairdressing salon. Four days post piercing, she returned to the same salon for a haircut during which the pierced site was manipulated. She presented to her family physician and was treated unsuccessfully with oral cephalexin. She was then referred to an infectious diseases consultant and received antipseudomonal intravenous antibiotics with subsequent resolution. She also required debridement and removal of necrotic cartilage. Public health investigation evaluated potential sources of infection including the piercing gun, disinfectant solutions, and hair cutting spray water bottles. Final culture results of the ear helical aspirate grew Pseudomonas aeruginosa. Pseudomonas aeruginosa was also cultured from one of the water bottles used to wet her hair during the haircut.

Discussion: Although the pseudomonal strains from the water bottle were different than the infecting one, this contamination presents a potential source of wound infection. Damage to the helical cartilage caused by the piercing gun may also have contributed to this infection. Initial empiric antibiotic therapy for these kinds of infection must include anti-pseudomonal coverage. Auricular or high helical ear piercing using a piercing gun is not recommended.

MeSH terms: Ear piercing; ear cartilages; pseudomonas infections

A uricular or high helical ear piercing has become an increasingly widespread fashion trend in recent years and is commonly available at most piercing salons. Unlike piercings through soft tissues, cartilaginous piercings are theoretically at higher risk of serious infective complications due to die avascular nature of cartilage.1-4 Healing is further hindered by the presence of an indwelling foreign body. Auricular perichondritis, despite increasing knowledge and awareness, is still a major post-piercing complication of high ear piercing, with reported rates doubling in England between the early and late 1990s.5 Rates of infection are reported to be higher during the summer months due to perspiration triggered by warm weather events and water activities.3 Piercing guns are believed to increase the risk of complication because they apply a shearing force to the perichondrium causing the perichondrium to slip off of the cartilage.1,6,7 As a result, die avascular cartilage is less likely to survive. However, there are reports of auricular perichondritis occurring secondary to needle piercing and acupuncture as well.8,9 Poor antiseptic technique and the use of benzalkonium chloride (vs. 70% alcohol solutions or iodine) as the pre-piercing cleaning agent also increase the risk of infection.1

The present case demonstrates a recognized and potentially disfiguring complication of high ear piercing, and suggests personal and public health measures that could be taken to prevent its occurrence.

METHODS

Case report

An eleven-year-old girl presented to the Children's Hospital Emergency Department in Winnipeg with a painful and swollen left ear following piercing of the left helix. She had had a "high ear" piercing of the left helical cartilage with a piercing gun at a local hairdressing salon 11 days prior to presentation. Three days following the piercing, redness and tenderness at the piercing site had been noted. On the fourth day after the piercing, she returned to the salon for a haircut, during which the piercing site was pulled and manipulated by the hairdresser's comb. The following day, the redness and tenderness worsened, and the girl went to her family physician, who removed the earring and started antibiotic treatment with oral cephalexin (50 mg/kg/day). …

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