A Case of Relapsing Polychondritis without Erythema and Swelling of the External Ears at the Time of Diagnosis

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We report on the case of a patient with relapsing polychondritis (RP) without erythema and swelling of the external ears at the time of diagnosis. A 75-year-old woman complained about swelling and redness of the left external ear at the first visit and was followed during 26 months. For the diagnosis of RP, all patients must satisfy at least 3 diagnostic criteria of McAdam et al. Further, the criteria of Damiani and Levine require that patients must satisfy at least 1 diagnostic criteria of McAdam et al. with histological confirmation. We had difficulty in making a definite diagnosis because our patient had only pain without swelling and redness at the second auricular chondritis. The patient’s condition improved after oral administration or drip therapy with prednisolone. Diagnosis was able to obtained from the patient’s condition on the basis of bilateral auricular chondritis, nasal chondritis, and the response to prednisolone. In one of the previous studies, Jung (1996) reported that the condition could be diagnosed by performing a biopsy even during an attack-free interval. Biopsy findings before the administration of prednisolone may facilitate a definite diagnosis at an early stage. RP is associated with progressive inflammation and destruction of systemic cartilage and connective tissue. Although no specific laboratory tests are available for the diagnosis of RP, determination of type II collagen antigen and human leukocyte antigen (HLA)-DR4 are associated with RP. However, these tests require personal information and cannot be covered by health insurance. However, if the patients do not meet all the diagnostic criteria, these laboratory tests and biopsy should be performed at an early stage to avoid development of a serious condition because of a relapse.

A Case of Relapsing Polychondritis without Erythema and Swelling of the External Ears at the Time of Diagnosis

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