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Gram-Negative Bacteremia With Atypical Neurologic Presentation Following Tattoo Application.

Adedolapo O Ojo¹, Desiree Marquez-Santos¹, Radmehr Rahemipour¹

¹Family Medicine, Episcopal Health Services, New York, USA.

|May 19, 2025

Summary

A diabetic woman developed a rare Escherichia coli (E. coli) bloodstream infection from a tattoo, despite no visible signs of local infection. This highlights the need for vigilance for systemic tattoo complications in high-risk individuals.

Keywords:

atypical presentation gram-negative bacteremia neurologic symptoms tattoo application tattoo infections

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Area of Science:

Infectious Diseases
Bacteriology
Dermatology

Background:

Tattoo-related infections commonly involve gram-positive bacteria (e.g., Staphylococcus aureus) with localized symptoms.
Systemic infections from tattoos are less common, often presenting with atypical clinical manifestations.

Observation:

A 48-year-old diabetic woman presented with systemic symptoms (fever, chills, weakness) suggestive of a neurological event.
No visible signs of infection were present at the tattoo site.
Laboratory tests revealed gram-negative bacteremia, with Escherichia coli identified as the causative agent.

Findings:

The tattoo was identified as the probable source of the Escherichia coli bacteremia.
The case presented an unusual absence of localized infection signs at the tattoo site.
Escherichia coli is a rare cause of systemic infection following tattooing.

Implications:

Clinicians must consider systemic infections, including rare gram-negative bacteremia, as potential tattoo complications, especially in immunocompromised or diabetic patients.
Early recognition of atypical presentations and prompt antibiotic treatment are crucial for favorable outcomes.
This case emphasizes the importance of stringent infection control practices during tattooing procedures.