title: Septic shock after posterior spinal arthrodesis on a patient with Scheuermann kyphosis and multiple body piercings.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  We report septic shock as postoperative complication following an instrumented posterior spinal arthrodesis on a patient with multiple body piercings. The management of this potentially catastrophic complication and outcome of treatment is been discussed.
  
  
  BACKGROUND
  Body piercing has become increasingly more common because of change in culture or as a fashion statement. This has been associated with local or generalized ill effects including tissue injury, skin and systemic infections, and septic shock. There is no clear guideline pathway regarding removal and reinsertion of body piercings in patients who undergo major surgery. Complications following orthopedic or spinal procedures associated with body piercing have not been reported.
  
  
  METHODS
  We reviewed the medical notes and radiographs of an adolescent patient with Scheuermann kyphosis and multiple body piercings who underwent a posterior spinal arthrodesis and developed septic shock.
  
  
  RESULTS
  Septic shock developed on postoperative day 2 after reinsertion of all piercings following the patient's request. The patient became systemically very unwell and required intensive medical management, as well as a total course of antibiotics of 3 months. The piercings remained in situ. She did not develop a wound infection despite the presence of bacteremia and spinal instrumentation. The patient had no new piercings subsequent to her deformity procedure. Two and a half years after spinal surgery she reported no medical problems, had a balanced spine with no loss of kyphosis correction and no evidence of nonunion or recurrence of deformity.
  
  
  CONCLUSIONS
  The development of septic shock as a result of piercing reinsertion in the postoperative period has not been previously reported. This is an important consideration to prevent potentially life-threatening complications following major spinal surgery.
authors.affiliation: Scottish National Spine Deformity Center, Royal Hospital for Sick Children, Edinburgh, United Kingdom. atsirikos@hotmail.com
authors.forename: Athanasios I
authors.initials: AI
authors.lastname: Tsirikos
authors.forename: Ashok Sridhara
authors.initials: AS
authors.lastname: Subramanian
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D046288:Body Piercing / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011859:Radiography; D012544:Scheuermann Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents