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Clinical Challenge
June 2018

Auricular Swelling After Mild Trauma

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, University of California San Diego, San Diego
  • 2Department of Pathology, Southern California Kaiser Permanente Medical Group, San Diego
  • 3Department of Otolaryngology–Head and Neck Surgery, Southern California Kaiser Permanente Medical Group, San Diego
JAMA Otolaryngol Head Neck Surg. 2018;144(6):535-536. doi:10.1001/jamaoto.2018.0069

A woman in her 50s presented with left auricular pain and malaise after failed treatment with a series of antibiotics (ceftriaxone, dicloxacillin, cefpodoxime, sulfamethoxazole-trimethoprim, and ciprofloxacin) for presumed cellulitis. The pain began with a small lesion on her left auricle after minor blunt trauma. She had no fevers, chills, arthritis, or other lesions. On examination, her left auricle was red and swollen with sparing of the lobule—a classic presentation for perichondritis. There was no fluid collection or skin ulceration, and the bony ear canal was normal. Results from an exhaustive autoimmune workup (tests for white blood cell count, cardiolipin level, IgG level, IgM level, rheumatoid factor blood test, hepatitis B virus, hepatitis C virus, creatinine level, antineutrophil cytoplasmic antibodies test, antinuclear antibodies test, cryoglobulin test, liver function test, C-reactive protein, erythrocyte sedimentation rate) were unremarkable. Previous skin swab cultures had grown Enterobacter aerogenes (susceptible to ciprofloxacin), but pain and edema acutely worsened with new onset of drainage and crusting despite ciprofloxacin treatment (Figure, A). Given the refractory course, biopsy specimens were obtained (Figure, B).