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Relapsing Polychondritis

Steven F. Isenberg

Published 1997 in Otolaryngology Head & Neck Surgery

ABSTRACT

A 72-year-old man came to the office with a 10-day history of swelling, pain, and erythema involving his auricle, hoarseness and mild throat soreness, swelling in his left neck, and moderate nasal discomfort with swelling. He had a history of intermittent swelling and erythema of his left auricle that he thought was the result of environmental exposure and that usually spontaneously resolved. This was the first time he had had associated symptoms in the nose and throat. Physical examination of the head and neck revealed diffuse edema and erythema of the left auricle with sparing of the lobule, tender swelling in the neck just to the left side of the lateral border of the thyroid cartilage, and tenderness over the dorsum of the nose (Fig. 1). Flexible laryngoscopy demonstrated good vocal cord mobility with minimal edema and some erythema involving the left arytenoid cartilage. Findings of a biopsy specimen of his ear cartilage 5 years before presentation were negative. He was subsequently referred to a rheumatologist, who confirmed the diagnosis on examination and history. Examination revealed some Raynaud's symptoms in the fourth and fifth fingers of the right hand. The patient responded to tapered doses of oral prednisone starting at 60 mg/day. Relapsing polychondritis (RP) is a rare disorder that frequently presents initially to otolaryngologists and can easily be mistaken for infectious cellulitis. The result of an autoimmune phenomenon, it presents with inflammation and destruction of both auricular and nonauricular cartilage, with the external ear and joint cartilage most often involved. 1 In this case the patient had chondritis of the nasal cartilage (nasal pain), involvement of the laryngeal cartilage (neck swelling), and auricular swelling and erythema. Usually indolent with multiple exacerbations, respiratory, cardiovascular, renal, or neurologic complications can result in rapid fatality. RP can also involve ocular tissues with reports of scleritis, episcleritis, keratitis, and choroidoretinal involvement. 2 Bilateral vocal cord paralysis has also been reported) The diagnosis of RP is usually made on a clinical basis. 4 Treatment includes high-dose, long-term steroid therapy with the possible need for immunosuppressive agents such as

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