A 22-year-old woman with no significant medical history presented with a 2-month history of fevers, shortness of breath, and right-sided pleuritic chest pain. She reported a 2-day history of skin lesions on her ears without trauma. She also reported no recent sick contacts, travel, illicit drug use, or use of oral contraceptive pills or other medications. Vital signs included a blood pressure of 140/70 mm Hg, heart rate of 168/min, respiratory rate of 30/min, temperature of 40.9°C, and oxygen saturation of 90% on room air. Physical examination revealed decreased right basilar breath sounds with dullness to percussion, tachycardia without murmurs or rubs, lower extremity edema, and bilateral cutaneous necrosis of her pinnae (Figure 1).
Phan KM, Nguyen KH, Crum-Cianflone NF. Cutaneous Necrosis of the Ears. JAMA. 2016;316(4):450-451. doi:10.1001/jama.2016.7847