FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
A 52-year-old man with human immunodeficiency virus (HIV), AIDS, chronic hepatitis B, and stage IV Burkitt lymphoma presented to the emergency department with a 2-week history of nausea, vomiting, diarrhea, and lethargy as well as a 2-day history of falls at home. He reported no vertigo, tinnitus, otalgia, or otorrhea; however, he did report a 2-month history of left-sided aural fullness and subjective hearing loss.
On physical examination, the left tragus, antitragus, and conchal bowl (Figure 1) exhibited nontender purple nodules and plaques extending into the cartilaginous external auditory canal. The external auditory canal was patent but narrowed. The tympanic membrane was intact and there was no otorrhea. There was no trismus or tenderness of the temporomandibular joint. A Weber test demonstrated lateralization to the right, and the results of a Rinne test were positive bilaterally. Relevant laboratory findings included a viral load of 152 000 copies/mL and a CD4 cell count of 8/μL. A skin punch biopsy specimen was obtained for histopathologic evaluation (Figure 2 and Figure 3).
Nervi SJ, Benson B, Gounder S, Jyung R. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2006;132(5):555. doi:10.1001/archotol.132.5.555