HPI: 

• 64 yo female with redness and swelling of left ear with some pain, no fevers
• No animal contacts, no pets, no swimming or foreign travel
• No allergies, no new medications/detergents
• No abrasions or new piercings
• No trauma or difficulty hearing

Pmhx: NIDDM, HTN

Physical Exam

• Normal vitals, afebrile
• Ear warm, diffusely erythematous, sparing lobule, minimal tenderness, no pain with movement of ear, no pain or swelling of mastoid. TMs clear and mobile, no erythema, pain, or swelling in the external auditory canal. Small area of skin breakdown around a pre-existing cartilaginous piercing.

Ddx: cellulitis, otitis externa, perichondritis, mastoiditis

ED treatment and clinical course:

• Given age, hx of DM, and c/f perichondritis given clinical exam, we started her on IV ciprofloxacin and admitted her to the observation unit for ENT consult in the morning
• Additionally, historically perichondritis has a high rate of oral antibiotic failure

Take home points regarding perichondritis:

• Can occur secondary to injury (even minor abrasion/skin breakdown), piercing, trauma, surgery, burns
• Lobule spared - only cartilaginous areas affected
• Antipseudomonal antibiotics (Pseudomonas > S. aureus or S. pyogenes)
• Consider I&D’ing if abscess, requires OMFS or ENT consult or follow up
• Untreated auricular hematoma or abscess is at risk for developing cauliflower ear via liquefying necrosis