A 69-year-old man presented with a swollen left auricle. He had no improvement with a course of topical mupirocin. After 4 weeks, he reported worsening pain and swelling and could no longer tolerate sleeping on the affected side. The patient had no ear drainage, trauma, hearing changes, vertigo, or fever. His history included a similar episode 10 years earlier that resolved spontaneously. Physical examination revealed a red, tender, swollen left auricle, with sparing of the lobule (Figure 1).

QUESTION

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Acute otitis externa.

• B. Chondrodermatitis nodularis helicis.

• C. Granulomatosis with polyangiitis.

• D. Herpes zoster oticus.

• E. Relapsing polychondritis.

DISCUSSION

The answer is E: relapsing polychondritis. This is a rare, multisystem autoimmune condition of cartilaginous structures that typically features recurrent self-limited flare-ups. Peak onset occurs between 40 and 50 years of age.¹ Relapsing polychondritis is strongly associated with other concurrent autoimmune disorders. The auricle is the most common site of inflammation with sparing of the noncartilaginous lobule. Nasal chondritis and migrating nonerosive oligoarthritis are also typically present.