Lip piercing-related prosthetic aortic graft infection and mediastinitis in filaminopathy: A case report.

We report a rare case in which a lip piercing led to Staphylococcus aureus bacteremia and subsequent prosthetic aortic graft infection complicated by anterior mediastinitis in a patient with filaminopathy A. A 32-year-old woman, who had undergone valve-sparing aortic root and arch replacement with a hybrid thoracic stent graft 5 years earlier, presented 3 weeks after a lip piercing with fever, chest pain, and elevated inflammatory markers. Computed tomography revealed a periprosthetic fluid collection and mediastinal inflammation consistent with graft infection. Blood cultures grew methicillin-sensitive S aureus. Despite early intravenous antibiotics, rapid progression to anterior mediastinitis and a large retrosternal abscess mandated radical surgical explantation of all prosthetic material and in situ reconstruction using multiple cryopreserved aortic allografts. She completed 6 weeks of intravenous cefazoline followed by prolonged oral antimicrobial therapy. At 4 months, imaging showed patent reconstruction and no residual infection. This case underscores the potential increased risk in patients with heritable aortopathies and vascular prostheses to bacteremia-related complications and highlights the importance of preventive counseling regarding procedures that may cause transient bacteremia, including oral piercings.