Chronic Rhinotillexomania Leading to Multiple Infectious Sequelae in a 66-Year-Old Female.

Rhinotillexomania, more commonly known as nose-picking, is a body-focused repetitive behavior that involves compulsive picking of the nares. While nose-picking in general is a common and largely unharmful practice worldwide, severe complications from chronic nose-picking do exist. This case highlights a 66-year-old female with a longstanding history of nose-picking and nose blowing who presented to the emergency department with acute delirium and various bodily complaints. She was subsequently admitted multiple times for recurrent sepsis, meningitis, endocarditis, cystitis, and discitis with each culture positive for methicillin-sensitive  (MSSA) with identical antibiotic sensitivities. Further imaging failed to reveal an underlying greater pathology. Intranasal swab revealed identical culture and sensitivity results as previous blood, CSF, and urine cultures and was thus hypothesized to be the source of infection. This case aims to elucidate the harmful effects of nose-picking as well as the importance of prevention, diagnosis, and management.