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JAMA Dermatology Clinicopathological Challenge
March 2016

Inflexible Ears

Author Affiliations
  • 1Department of Pathology, Virginia Commonwealth University Health System, Virginia Commonwealth University School of Medicine, Richmond
  • 2Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 3Dermatology at West Virginia School of Osteopathic Medicine, Lewisburg
JAMA Dermatol. 2016;152(3):335-336. doi:10.1001/jamadermatol.2015.4761

A man in his 70s presented for evaluation of a nonhealing lesion of his left cheek. Examination of the head and neck revealed the incidental finding of bilateral auricular rigidity and immobility. Both ears appeared normal and were nontender and asymptomatic (Figure, A). The patient recalled that his barber had noted an increase in difficulty trimming hair in the areas around his auricles owing to their inflexibility. The only other notable finding was increased rigidity of his nasal cartilage. The patient denied any decrease in auditory acuity, frostbite, or any previous trauma to his ears. His medical history included type 2 diabetes mellitus, hypertension and secondary chronic renal insufficiency, cardiovascular disease, and gout. His long-term medications included lisinopril, glipizide, terazosin, insulin glargine, labetalol, allopurinol, hydrochlorothiazide, and erythropoietin. An incisional biopsy of his left auricle was performed. Hematoxylin-eosin staining of the biopsy specimen showed regions of ossification and calcification (Figure, B). A computed tomographic (CT) scan of the head was performed within 2 weeks of his original biopsy and showed extensive calcification in the area of the auricles (Figure, C). The patient’s laboratory workup showed an elevated creatinine level of 1.8 mg/dL (reference range, 0.6-1.2 mg/dL), which had been his baseline level for the past 2 years. He had a hemoglobin level of 11.1 g/dL (reference range, 14-18 g/dL), which was felt to be secondary to his chronic renal failure. His serum calcium level had been normal with the exception of an elevated value noted of 10.4 mg/dL noted 1 year ago (reference range, 8.7-10.2 mg/dL). His phosphorus, alkaline phosphorus, electrolyte, and AM cortisol levels; parathyroid function; and thyroid function were within normal limits.

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