PDF(Pubmed)
Abstract：
Relapsing polychondritis (RPC) is a rare autoimmune condition that often mimics recurrent external otitis. This multisystemic disease primarily affects cartilaginous structures in the body, with the ear pinna being the most commonly impacted. RPC is associated with elevated inflammatory markers and antinuclear antibodies (ANA), and it can lead to chondral destruction. Our case is a 74-year-old Caucasian male with a history of peripheral vascular disease (PVD) who presented to the clinic with recurrent, painful swelling of the right upper ear for 14 days despite multiple antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). He had chronic sensorineural hearing loss in the same ear. He was seen multiple times with identical symptoms in the last seven months and was diagnosed with otitis externa. He denied arthritis, fatigue, rash, abrasion, allergies, trauma, or fever. He was prescribed antimicrobials, alternating NSAIDs, and methylprednisolone with temporary relief. He is only on statins and has an unremarkable family history. He was afebrile with normal vital signs. On physical examination, he was not in acute distress and had a normal voice but had a diffusely erythematous, tender, swollen right ear pinna and external canal sparing the lobe. The rest of the physical examination was unremarkable. Laboratory results showed elevated C-reactive protein (CRP) of 100 mg/L (normal range: <3 mg/L) and erythrocyte sedimentation rate (ESR) of 200 mm/hour (normal range: <20 mm/hour). ANA titer is 1:160 with a homogenous pattern, but other autoantibodies were negative. No red flags were noted on the complete blood count (CBC) or comprehensive metabolic panel (CMP), and his rapid plasma reagin (RPR) test was negative. In this patient, prednisone 60 mg daily was initiated as monotherapy, and rheumatology was also consulted. The patient sought consultation due to recurrent and persistent upper ear infections despite antibiotic treatment and was ultimately diagnosed with a rare medical condition called relapsing polychondritis. Following this treatment, the auricular chondritis improved promptly. The steroid dosage was then slowly tapered and maintained at 10 mg daily to prevent flare-ups. Subsequently, after the initiation of corticosteroids, inflammatory markers trended down to normal levels.
摘要：
复发性多软骨炎（RPC）是一种罕见的自身免疫性疾病，通常模仿复发性外耳炎。这种多系统疾病主要影响体内的软骨结构，耳廓是最常见的影响。RPC与炎症标志物和抗核抗体（ANA）升高有关，会导致软骨破坏.我们的病例是一名74岁的白人男性，有外周血管疾病（PVD）的病史，他在临床上反复发作，尽管使用了多种抗生素和非甾体抗炎药（NSAIDs），但右上耳疼痛肿胀14天。他在同一只耳朵患有慢性感觉神经性听力损失。在过去的七个月中，他多次出现相同的症状，并被诊断出患有外耳炎。他否认关节炎,疲劳,皮疹,磨损,过敏,创伤,或发烧。他开了抗菌药物，交替NSAIDs，和甲基强的松龙暂时缓解。他只服用他汀类药物，家族史平淡无奇。他发热，生命体征正常。在体检时，他没有急性痛苦，声音正常，但有弥漫性红斑，tender,肿胀的右耳耳廓和外管保留肺叶。其余的体检并不显著。实验室结果显示，C反应蛋白（CRP）升高100mg/L（正常范围：<3mg/L），红细胞沉降率（ESR）200mm/小时（正常范围：<20mm/小时）。ANA滴度为1：160，具有均匀的模式，但其他自身抗体呈阴性。在全血细胞计数（CBC）或综合代谢面板（CMP）上没有注意到危险信号，他的快速血浆反应素（RPR）试验为阴性。在这个病人身上,泼尼松每天60毫克开始作为单一疗法，和风湿病也被咨询。尽管进行了抗生素治疗，但由于反复和持续的上耳感染，患者仍寻求咨询，最终被诊断出患有罕见的疾病，称为复发性多软骨炎。经过这种治疗,耳廓软骨炎迅速好转。然后将类固醇剂量缓慢减少并维持在每天10mg以防止突然发作。随后，开始使用皮质类固醇后，炎症标志物下降到正常水平。
