DR.MOHAMMED IRFAN SHEIKHabout 5 years ago

Polychondritis with Auricular and Ocular Involvement

A 46-year-old man presented with a 1-month history of bilateral auricular pain and swelling of the pinnae, followed by bilateral eye redness, pain, and photophobia. Review of systems was notable for pain in the right wrist. Examination revealed bilateral erythema and tenderness of the auricles and thickening and deformity of the pinnae with sparing of the ear lobules (Panel A) and no joint abnormalities. The right tympanic membrane was congested. Ophthalmologic examination revealed bilateral congestion and inflammation of the conjunctival, episcleral, and scleral vessels (Panel B). The congested area did not blanch with the instillation of phenylephrine eyedrops — a finding that is consistent with a diagnosis of scleritis. Posterior scleritis was identified by the presence of bilateral optic-disk edema and hyperemia on slit-lamp examination and by the presence of a thickened sclera on ultrasonography. Laboratory workup was unrevealing. The patient was treated with prednisone, topical glucocorticoids, and cycloplegic eyedrops, with a good response.