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Miscellanea
Images in paediatrics
A child with a painful swollen ear
  1. Chris A Rees1,
  2. Daniel M Rubalcava2,
  3. Corrie E Chumpitazi2
  1. 1 Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Corrie E Chumpitazi, Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1850, Houston, TX 77030, USA; corriec{at}bcm.edu

https://doi.org/10.1136/archdischild-2015-310310

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    A previously healthy 2-year-old boy presented to the emergency department with a 1-day history of pain, swelling and redness of his left auricle, which spared his earlobe (figure 1). There was no reported preceding trauma, fever or otorrhea, and no history of otitis media or change in hearing. On examination, there was erythema, oedema and warmth with tenderness on moving the auricle but no fluctuance or mastoid swelling. His ear canals were clear bilaterally. The diagnosis of auricular perichondritis was made on clinical impression. He was admitted overnight, treated with intravenous cefepime and clindamycin, and monitored for 1 day to ensure improvement. His symptoms improved and he was discharged home to complete a course of oral ciprofloxacin and clindamycin.

    Figure 1
    Figure 1

    Left ear with erythema, oedema, and a waxy appearance of the skin of the auricle with involvement of the lobule.

    Auricular perichondritis is an inflammatory condition of the scapha cartilage of the outer ear. It classically presents with erythema, warmth and swelling of the auricle and pain with manipulation.1 It is most commonly caused by the pathogens Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pyogenes.2 Cases have been reported after ear piercing, blunt trauma and surgical procedures,3 although this child had no obvious trigger factors. High rates of oral antibiotic treatment failure have been documented, suggesting that patients may require a short course of intravenous antibiotics prior to transitioning to oral antibiotic therapy.2 Auricular perichondritis may be the sentinel event in relapsing perichondritis; an uncommon autoimmune condition that affects cartilage throughout the body.4 Relapsing perichondritis is more common in adults than in children and typically responds to immunomodulator therapy.5

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    Footnotes

    • Contributors Both DMR and CEC attended to this patient in the emergency department. CAR wrote the first draft of the manuscript, and DMR and CEC provided revisions and assisted with references.

    • Competing interests None declared.

    • Patient consent Obtained from the parents.

    • Provenance and peer review Not commissioned; externally peer reviewed.