Images in Clinical Medicine
Red Puffy Ears
N Engl J Med 2010; 362:928March 11, 2010
- Article
A 63-year-old man with a history of recurrent aseptic meningitis presented with fever and headache. The physical examination showed scleral injection and mild nuchal rigidity. Analysis of the cerebrospinal fluid revealed a mild monocytic pleocytosis indicative of aseptic meningitis. Despite supportive care, the patient had persistent fevers, anorexia, and headache. During treatment, marked bilateral auricular swelling and redness developed (Panel A). Auricular biopsy showed inflammatory changes that are seen in relapsing polychondritis. The administration of a corticosteroid improved the meningeal symptoms and reduced the auricular swelling (Panel B) within a few days. Relapsing polychondritis is a rare rheumatologic disorder that is characterized by recurrent inflammation of cartilage throughout the body. In rare cases, selected connective tissue such as the meninges can be affected, which in this patient caused the presenting symptom of meningitis.
Hiromichi Kawai, M.D.
Atsusi Nakajima, M.D.
Shiga University of Medical Science, Otsu, Japan
hirok@belle.shiga-med. ac. jp - Citing Articles (1)
Citing Articles
1
Z.J. Wang, C.Q. Pu, Z.J. Wang, J.T. Zhang, X.Q. Wang, S.Y. Yu, Q. Shi, J.X. Liu, X.L. Huang, C.J. Fu, A.J. Liu, X.S. Huang. (2011) Meningoencephalitis or meningitis in relapsing polychondritis: Four case reports and a literature review. Journal of Clinical Neuroscience 18:12, 1608-1615
CrossRef
