B49-22 When the Heart Gets Inked: Tattoo-Associated Infective Endocarditis With Septic Emboli and Mitral Regurgitation-Induced Pulmonary Congestion in a Healthy Young Male

Introduction Infective endocarditis (IE) is a rare but potentially fatal infection, with an incidence of approximately 10 cases per 100,000 persons annually. Body art, including piercings and tattoos, has become increasingly popular, particularly among young individuals. Although IE is an uncommon complication of body art, it may occur when tattooing is performed under unhygienic or non-aseptic conditions, raising important public health concerns. We present a case of tattoo-associated infective endocarditis in a healthy young male, with complicated by septic emboli and acute pulmonary congestion from severe mitral regurgitation (MR). Case Report A 23-year-old male with no prior medical history presented after outpatient blood cultures grew Gram-positive cocci. He reported developing multiple forearm abscesses following tattoos received during a recent trip to Vietnam, which were treated with antibiotics. Over subsequent months, he developed intermittent fevers, night sweats, weight loss, malaise, and progressive exertional dyspnea. On presentation, he was tachycardic but hemodynamically stable with an oxygen saturation of 92% on room air. Examination revealed extensive tattoos over chest and upper extremities with healing superficial ulcerations but no signs of cellulitis, and a grade 3/6 holosystolic murmur at the apex radiating to the axilla. Laboratory findings showed neutrophilic leukocytosis and elevated ESR and CRP. Empiric intravenous antibiotic therapy with vancomycin, cefepime, and metronidazole was initiated. Repeated blood cultures grew Streptococcus sanguinis. Echocardiography demonstrated severe MR with P3 leaflet perforation and mobile vegetations, along with a left-to-right interatrial shunt. CT imaging revealed splenic and right renal wedge-shaped infarcts consistent with septic emboli. Cardiothoracic surgery was consulted, and the patient underwent surgical intervention with mechanical valve replacement and ligation of the atrial septal defect. Intraoperative valve cultures grew Staphylococcus epidermidis. Postoperatively, the patient was treated with vancomycin, gentamicin, and rifampin, and anticoagulated with warfarin (INR target 2.5-3.5). He completed a 6-week antibiotic course with full clinical recovery and resolution of pulmonary congestion on follow-up imaging. Discussion/Conclusion Tattoo-associated left-sided IE is exceedingly rare and can present with respiratory symptoms secondary to acute MR-induced pulmonary venous congestion. This case underscores the intersection of cardiac and pulmonary pathophysiology in systemic infection and highlights the need for clinician awareness of tattoo-related bacteremia as a potential source of severe cardiopulmonary complications. Early recognition and multidisciplinary management are crucial for preventing irreversible valve and pulmonary damage. This abstract is funded by: None