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Nose ring blamed for life-threatening infection that 'killed' woman's liver

Weeks after she had her nose pierced, she started to develop worrisome symptoms.
Woman gets infected with hepatitis B after getting her nose pierced and goes into liver failure. She had to have a liver transplant.
Dana Smith had to be placed in a medically induced coma when brain swelling from her infection caused seizures.Courtesy Dr. Lewis Teperman
/ Source: TODAY

A tiny stud in a woman’s nostril is likely to blame for a huge health emergency that sent her to the hospital with liver failure, doctors say.

They believe the nose piercing was the source of a hepatitis B infection that injured her liver, causing brain swelling and other life-threatening complications, ultimately requiring a liver transplant.

“If I would have waited another day (to get help), my chances of survival were very, very thin,” Dana Smith, 37, who lives in Queens, New York, told TODAY.

“She was in such dire straits,” added Dr. Lew Teperman, director of organ transplantation at Northwell Health in Long Island, New York. “It was a miracle that we were able to get a liver in time.”

Smith said she was in good health when she decided to get a nose ring last Thanksgiving. It was around the time of her birthday and she’d been thinking about getting the piercing for a few years. When a friend decided to get one, too, it seemed like the perfect time to do it, she recalled.

The friend picked the place — a body piercing studio at a nearby mall. Smith knew a couple of people who had piercings done there, “so I felt like it was OK,” she said.

Smith had no concerns about the shop, the procedure, the staff or the cleanliness of the equipment when she got the nose ring, she recalled.

“I didn't have any irritation, no redness anything,” she said. “I didn't have any issues with the actual piercing itself.”

On Jan. 10, she started having dull stomach pains, likening the ache to a stomach virus, and lost her appetite. The next day, she started to throw up and thought she ate something that triggered her acid reflux.

“But this was for a couple days — I just couldn't hold down anything,” Smith said. “(Then) I started to throw up blood.”

Her sister took her to the hospital. Smith doesn’t remember anything after that until she woke up on Jan. 20 and was told she had a new liver.

Teperman, her doctor, delivered the news, relieved that Smith emerged from a medically induced coma that was necessary after brain swelling from the infection caused seizures. It was their first conversation, but he first saw her days earlier when she was transferred to North Shore University Hospital in Manhasset, New York, and already unresponsive.

Tests showed she had fulminant hepatitis B liver failure, a rare but rapidly-progressing, life-threatening condition.

“She responded overwhelmingly to the virus and her body was working on clearing it, but it killed her liver,” Teperman said.

To survive, Smith needed a donor liver within five days. She was put on the liver transplant list and given the highest status in the country on the United Network for Organ Sharing.

Three days later, a liver became available from a deceased 35-year-old woman. Teperman and his team transplanted it on Jan. 17, but he worried about all the seizures Smith went through: “Is there any damage done to the brain and is she going to wake up? That is the most hair-raising part of this,” he said.

Woman gets infected with hepatitis B after getting her nose pierced and goes into liver failure. She had to have a liver transplant.
Dr. Lew Teperman had his first conversation with Smith after she emerged from a medically induced coma.Courtesy Dana Smith

When Smith successfully emerged from her coma and the tape holding her breathing tube in place was removed from her mouth, Teperman noticed the stud in her nose and asked her about it.

Everything fell into place.

“The timing was perfect for it having caused the hepatitis B and the fulminant failure,” he said. “There were no other risk factors at all. This was it — it all made sense.”

Hepatitis B is spread when blood, semen or other body fluid infected with the virus enters the body of someone who is not infected, according to the Centers for Disease Control and Prevention. You can become infected from exposure to an infected person’s blood through needlesticks or other sharp instruments.

People who are tattooed or pierced under unsterile conditions are at risk for getting the virus unless they are vaccinated against it, the Hepatitis B Foundation warned.

Woman gets infected with hepatitis B after getting her nose pierced and goes into liver failure. She had to have a liver transplant.
Smith and Teperman reunite a month after her liver transplant.Courtesy Northwell Health

Teperman is 90% sure the piercing was the source of the infection — the entry of the virus to her body.

Smith said she doesn’t blame the body piercing studio, but believes the infection got into her system through the open wound sometime after the stud was inserted. She doesn’t regret getting the nose ring, which is still in place, but won’t allow her teenage daughter to get one until she’s an adult.

Smith’s prognosis is “perfect” and she will be able to resume her regular daily activities, Teperman said.

He recommended everyone get the hepatitis B vaccine, which is available for all age groups. He also advised people interested in getting a body piercing to carefully evaluate the shop. The nose is very vascular, so anything that enters into a blood vessel there would transmit quickly, he noted.

“I believe the large majority of these places all practice good hygiene and they should be even more vigilant now with COVID,” Teperman said. “But I did tell my daughter that I do not want her to have a nose ring.”