Pinna perichondritis due to Pseudomonas aeruginosa after piercing in a pediatric patient: a case report with surgical debridement

Background: Body modification practices, such as piercings and tattoos, have increased among teenagers and young adults in recent years. However, some of these procedures are performed using inappropriate techniques or by inexperienced personnel, increasing the risk of complications such as lacerations, localized infections, impaired wound healing, and contact dermatitis. Pinna piercings may result in perichondritis— an infection of the auricular cartilage and perichondrium—which can progress to abscess formation, tissue necrosis, and permanent esthetic sequelae. We present an unusual case of perichondritis in a pediatric patient caused by Pseudomonas aeruginosa after a recent helix piercing, highlighting the importance of early recognition and targeted antimicrobial therapy to prevent long-term deformities. Case Description: We report the case of a 14-year-old Latin female who presented with erythema, warmth, edema, moderate pain, and fever for 2 days after a recent right helix piercing. Examination revealed perichondritis with a perichondral abscess, requiring surgical drainage. Initial therapy with a thirdgeneration cephalosporin and a lincosamide was chosen to provide broad coverage, including for methicillinresistant Staphylococcus aureus (S. aureus) and Gram-negative organisms. After culture confirmation of Pseudomonas aeruginosa, the regimen was escalated to cefepime (2 g every 8 h for 10 days) due to its superior anti-pseudomonal efficacy. Despite comprehensive multidisciplinary management and favorable clinical evolution, the patient experienced significant cartilage loss with persistent esthetic deformity. Conclusions: Perichondritis is a potentially disfiguring infection of the auricular cartilage, most caused by Pseudomonas aeruginosa, though S. aureus may also be implicated. While narrow-spectrum antibiotics targeting S. aureus may suffice in some cases—supporting rational antibiotic use—local flora and individual risk factors must guide therapy. This case underscores the importance of early diagnosis, prompt initiation of appropriate antibiotic treatment, and timely referral to otorhinolaryngology services to prevent irreversible esthetic damage and cartilage loss.