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Calvaria Osteomyelitis and Cellulitis Complicating Body Art

Graef, Benjamin DO; Tan, Michael J. MD*†

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Infectious Diseases in Clinical Practice: July 2006 - Volume 14 - Issue 4 - p 231
doi: 10.1097/01.idc.0000225100.57415.78
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A previously healthy 23-year-old man presented to our emergency department with forehead swelling. He had 4 cosmetic transdermal implants surgically placed along the midline of his scalp one year before. He "bumped his head" on the implants a few times over the last few months. Physical examination demonstrated 4 transdermal implants (Fig. 1) and swelling of his forehead with purulent drainage from the anteriormost implant site. A computed tomography scan and reconstruction of his head (Fig. 2) demonstrated the implants and calvaria osteomyelitis and bone destruction. Operative site cultures of fluid and subcutaneous tissue taken during implant removal grew viridans streptococci, Staphylococcus aureus, and Propionibacterium acnes. Soft tissue swelling improved in response to intravenous piperacillin/tazobactam. Surgical debridement of the calvaria was planned, but the patient was lost to follow-up. Although this appears to be the first described case of calvaria osteomyelitis complicating body art, complications such as cellulitis and perichondritis have been associated with body piercings.1,2 This patient's presentation stresses potential complications of body art.

Transdermal implants and associated forehead swelling. TD indicates transdermal implants.
A computed tomography scan and reconstruction of the head. TD indicates transdermal implants; and O, calvaria osteomyelitis and bone destruction.


1. Yahalom S, Eliashar R. Perichondritis: a complication of piercing auricular cartilage. Postgrad Med J. 2003;79:29.
2. Mayers LB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clin Proc. 2002;77:29-34.
© 2006 Lippincott Williams & Wilkins, Inc.