Necrotizing Fasciitis Occurring After a Conventional Tattoo

Abstract

A 34-year-old patient presented to the emergency department after getting a tattoo from a licensed tattoo artist at home. The patient was in septic shock with renal failure, and the clinical examination revealed a skin infection at the tattoo site. Suspecting necrotizing fasciitis, the patient underwent fasciotomy with deep tissue sampling and vacuum-assisted closure therapy. Broad-spectrum antibiotic therapy was initiated and later adjusted based on bacterial culture results. The patient quickly recovered and was discharged from the intensive care unit. We report the first case of post-conventional tattoo necrotizing fasciitis in Belgium. The tattoo was performed by a professional licensed tattoo artist, equipped as required by Western legislation. Previously reported cases highlighted necrotizing fasciitis occurring after Samoan or Samoan-style tattoos, an ancestral practice with handmade tools. In our case, the tattoo was done in a conventional way with modern tools and techniques. It is the lack of hygiene precautions that we can attribute to the development of this serious pathology.

Keywords: broad-spectrum antibiotic; fasciotomy; necrotizing fasciitis; sepsis; tattooing.

Figure 1. Erythema and edema of the patient's forearm at the new tattoo site

Figure 2. Axial CT of the forearm shows subcutaneous fat infiltration and collection along the muscle planes from elbow to wrist

CT: computed tomography

Figure 3. Fasciotomy wound post-debridement of the forearm