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

J Adolesc Health. 2008 Sep;43(3):217-25. doi: 10.1016/j.jadohealth.2008.02.008. Epub 2008 May 12.


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.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Antibiotic Prophylaxis
  • Body Piercing / adverse effects*
  • Endocarditis / etiology*
  • Endocarditis / prevention & control
  • Female
  • Humans
  • Male
  • Tattooing / adverse effects*