Why is this ear painful, red, and swollen?

Dermclinic

For 1 week, a 35-year-old woman’s left ear has been very painful, erythematous, and swollen. There is no history of insect bite or trauma. Her condition improved only slightly after the physician she initially consulted prescribed methylprednisolone and cephalexin.

What do you suspect?

A. Bacterial cellulitis.

B. Fungal cellulitis.

C. Relapsing polychondritis.

D. Insect bite reaction.

E. Chondrodermatitis nodularis chronica helicis.

(Answer and discussion on next page)

Answer—Relapsing polychondritis

The patient has relapsing polychondritis, C, a diagnosis that is difficult to make without a biopsy. This condition is characterized by intermittent episodes of inflammation of cartilage that contains type II collagen, such as is found in the ears, trachea, and nose. Onset is typically in the fourth or fifth decade

Bacterial cellulitis usually responds to cephalexin, and fungal cellulitis is uncommon in healthy persons. Chondrodermatitis nodularis chronica helicis is a painful papule found on the helical rim; it affects primarily middle-aged men. ■