Management challenges of tongue piercing-associated mitral valve endocarditis with systemic embolization in a...

Infective endocarditis (IE) is a rare but serious condition in adolescents. While most cases are associated with dental procedures, oral piercings can also serve as an entry point for bacterial infection. A 16-year-old female with no prior medical history presented with severe pain in the left hypochondrium, accompanied by fever and rigors. She had undergone tongue piercing several months earlier and nasal piercing 1 week prior. Echocardiography revealed mitral valve IE with severe regurgitation. Streptococcus mitis was identified as the etiologic pathogen. Computed tomography scans revealed mycotic aneurysms in the right iliac artery and cerebral arteries. An endovascular approach was selected for revascularization, followed by mitral valve replacement with a mechanical prosthesis.

This case highlights the importance of early diagnosis and timely surgical intervention in adolescents with IE, especially those with oral piercings. Prompt endovascular revascularization and valve replacement are essential to prevent further systemic complications.