Not just for circus freaks

Even simple piercings could pose a serious health
risk to your patients

By Maria Turner

Body piercing , a trend that used to be limited to squeegee punks and rebel teens has now gone mainstream. According to Health Canada, the number of piercing shops has increased dramatically in the last few years. It's more than likely that you may encounter a patient in your practice who has a piercing, be it pierced ears, nose, navel, lip or tongue. As you are probably aware body piercing is not risk free. The body can often reject the jewelry, leading to inflammation, infection and scarring. There's also the risk of contracting hepatitis B, hepatitis C, HIV/AIDS, warts, herpes, toxic shock syndrome, skin tuberculosis, and inoculation leprosy. But now there may be another disease to add to that list.

A case study of a woman who suffered severe relapsing polychondritis (RP) following an ear piercing, published in a recent issue of The Journal of Rheumatology, illustrates a serious and long-lasting clinical consequence of piercing. RP is an extremelyrare chronic multi-system disorder characterized by recurrent episodes of inflammation of cartilaginous tissues. It can be life-threatening and it's very difficult to diagnose.

The 39-year- old woman initially had her ear pierced with a stainless steel ring in the upper third of the pinna in 1998, during her first pregnancy. The piercing remained painful and she changed the ring to a silver one, which she removed after a month due to persistent inflammation of the ear. Approximately six months after the problem had begun, she was diagnosed with ear chondritis with local Staphylococcus epidermis infection. Pristinamycine had no effect.

After giving birth to a normal boy, the patient complained of pain in her ribs and developed generalized chondritis of the nose, ribs, and respiratory tract. She then received a diagnosis of RP. She did not respond to dapsone, and prednisone had only a mild effect in relieving her inflammation.

By 2002 the patient was complaining of inspiratory dyspnea with wheezing, hoarseness, and weakness of the voice. Her nose and ears were inflamed and she had a "cauliflower ear" due to destruction of the cartilage of the auricle of the ear and collapse of the concha. Her ribs were painful and pressure on the thyroidal cartilage led to coughing. Laboratory findings tested positive for human anti-type II collagen antibodies, and endoscopy and a CT showed inflammation of the subglottic larynx and first tracheal ring, and chondritis of the thyroid and cricoid cartilages.

While the authors of the report did not completely rule out a "fortuitous association" between the ear piercing and relapsing polychondritis in their patient, they felt that the case for the piercing being the culprit is convincing. The onset of the disease came after the piercing and the patient had had no previous rheumatologic symptoms. Previous research has shown that commercial studs in contact with body fluid can trigger an inflammatory response and an animal model found that implanting metal ear studs in rats frequently causes chondritis. The authors noted that in their patient, hormonal and immunological modifications due to pregnancy may have played an additive role.

At the time of the report, the patient had been given steroid therapy with methotrexate and showed only a mild reduction in inflammation after 12 months.