SAEM Clinical Images Series: Not Your Average Ear Infection

ear infection

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. The patient was on amoxicillin for strep throat, which was diagnosed a week before the onset of his symptoms and was improving.

Physical Exam

Vitals: BP 130/68; HR 105; Temp 98.9°F; RR 22; O2 Sat 100% RA

General: Alert, interactive, well-appearing

HEENT: Left ear with moderate redness, swelling, warmth, and tenderness of the auricle sparing the lobule. Superficial lineal abrasion over concha, hemostatic. Ear canal and tympanic membrane normal.

Neck: Shotty left posterior cervical lymphadenopathy

Cardiovascular: Regular rate and rhythm, brisk capillary refill

Pulm: Clear to auscultation bilaterally

Abdomen: Soft, non-tender, non-distended

MSK/extremities: No edema

Skin: No rash except as noted

Laboratory Data

None

Case Question: What ear structure is involved in this infection?

This is a case of perichondritis of the auricle, or a bacterial infection of the ear’s cartilage. It often occurs in the setting of trauma, which may be occult. Findings suggestive of perichondritis (versus cellulitis) include sparing of the ear’s lobule. It is most commonly caused by p. aeruginosa and requires treatment with antibiotics providing anti-pseudomonal coverage to prevent permanent ear deformity.

Case Discussion

Take-Home Points

Consider the diagnosis of perichondritis when evaluating skin and soft tissue infections of the auricle.
Treat this condition with anti-pseudomonal antibiotics.

References

Davidi E, Paz A, Duchman H, Luntz M, Potasman I. Perichondritis of the auricle: analysis of 114 cases. Isr Med Assoc J. 2011 Jan;13(1):21-4. PMID: 21446231.
Klug TE, Holm N, Greve T, Ovesen T. Perichondritis of the auricle: bacterial findings and clinical evaluation of different antibiotic regimens. Eur Arch Otorhinolaryngol. 2019 Aug;276(8):2199-2203. doi: 10.1007/s00405-019-05463-z. Epub 2019 May 11. PMID: 31079204.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.