What is your diagnosis?
A 55-year-old male patient presented to the dermatology outpatient clinic with the complaints of redness and swelling of the right ear for the past two weeks. He stated that his ear was painful but did not itch or suppurate. There was no history of trauma. In the medical history, he had cough for one month and was treated with multiple oral and intramuscular antibiotics for the presumptive diagnosis of lung infection with no benefit. His left eye became red two days after cough onset. His eye
... gh onset. His eye did not get any benefit from topical cyclopentolate and various antibiotic eye drops either. He also had hemorrhagic nasal drainage and was diagnosed with sinusitis two weeks ago. He was again treated by various antibiotics with no clinical benefit for this complaint. Additionally, he had arthralgia affecting both knees. His medical history revealed that he had hypertension and diabetes and was using metformin and gliclazide. He never smoked. His family history was unremarkable. Dermatological examination showed erythema, swelling and tenderness of the right ear (Figure 1). Needle aspiration revealed no drainage or suppuration. There was also conjunctival hyperemia in his left eye (Figure 2). Laboratory examinations demonstrated a white blood cell count of 13200 /µL (with an increased neutrophil ratio of 71.8% and decreased lymphocyte ratio of 19.5%), a sedimentation rate of 82 mm/hr, and a C-reactive protein value of 72.0 mg/L. Test results for ANA, ANCA and HLA-B27 were all negative. His chest X-ray revealed an increased bronchial shadow and this was nonspecific (Figure 3). Histopathological examination of a punch biopsy specimen obtained from the right ear revealed a predominantly lymphocytic inflammatory cellular infiltrate in the subcutaneous tissue and cartilage. Figure 1. Clinical appearance of the red and swollen right ear of the patient