Body Piercing Complicated by Atypical Mycobacterial Infections Tammie Ferringer, M.D.,* Howard Pride, M.D.,* and William Tyler, M.D.*  Departments of *Dermatology and  Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania Abstract: Body piercing is a growing trend, especially in young people, but the literature on complications of piercing consists mostly of case re- ports involving ear piercing. Previous reported complications of piercing include contact dermatitis, keloids, traumatic tearing, viral transmission, and bacterial infections. We report two patients who presented with atypical mycobacterial infections of body piercing sites. It is important to recognize the association of piercing and mycobacterial infections so that tissue can be obtained for histopathologic examination and appropriate culture. Body piercing is becoming increasingly popular but little has been published on its complications. The available literature consists mostly of case reports involving ear piercing. Reported complications of piercing include contact dermatitis, keloids, traumatic tearing, viral transmission, and infections caused by Staphylococcus aureus, Group A beta-hemolytic Streptococcus, and in the case of perichondritis, Pseudomonas aeruginosa. We report two patients who presented with atypical mycobacterial infections of body piercing sites. A 12-year-old girl developed a Mycobacterium flavescens infection associated with eyebrow piercing. The second patient was a 22-year- old who grew Mycobacterium chelonae from a navel piercing site. CASE REPORTS Patient 1 A 12-year-old healthy girl presented with a nontender nodule on her left eyebrow at a piercing site performed at a local tattoo parlor. One month after the piercing, the site became erythematous and indurated. Despite removal of the ring, the lesion progressively enlarged over the next 6 months. There was no resolution after lancing and several courses of oral antibiotics. Physical examination revealed a 1-cm erythema- tous nonpurulent friable nodule of the left lateral eyebrow (Fig. 1). Two 2-mm punch biopsies were performed for pathologic review and for fungal and mycobacterial cultures. A diffuse inflammatory infil- trate of the dermis was noted consisting of histio- cytes, neutrophils, and small lymphoid cells. One portion contained the disrupted lining of a sinus tract. Auramine-rhodamine stain revealed two rod- shaped structures compatible with acid-fast bacilli. Mycobacterial cultures grew group II M. flavescens. Fungal cultures were negative. The patient was ini- tially treated with clarithromycin and rifampin but was switched to minocycline and rifampin based on susceptibilities. Treatment was continued for 1 year. Address correspondence to Tammie Ferringer, M.D., 100 N. Academy Ave., MC 14 06, Department of Dermatology, Geisinger Medical Center, Danville, PA 17822, or e-mail: tferringer@ geisinger.edu. DOI: 10.1111/j.1525-1470.2008.00638.x Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing, Inc. 219 Pediatric Dermatology Vol. 25 No. 2 219–222, 2008