Make the Diagnosis: Extreme Earache

Presentation

Case Findings: A 60-year-old woman presents with a 1-week history of swelling and extreme discoloration on her right ear.

What is your diagnosis?

Learnings

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is associated with significant morbidity and mortality. The purplish appearance of AAV is caused by focal necrotizing lesions in vessels and organs. In addition, alveolar hemorrhage, purpuric rash, and renal failure may occur.

This patient’s condition was caused by propylthiouracil (PTU), a common antithyroid agent, although other drugs can cause the condition as well. The mechanism of action remains unclear. The drug itself can cause bruising or bleeding independently, but in this case the vasculitis lead to the intensity of the blue discoloration.

What to Look For:

There are different types of AAV with different areas of blood vessels involvement, but vasculitis is a systemic condition, and other symptoms include fever, fatigue, aches and pains, weight loss, and rapid pulse. In general, ANCAs caused by PTU react to several components of myeloid granules, according to a study published in the journal Nature. This reaction can help distinguish PTU-induced AAV from primary AAV.

Treatment:

Treating AAV is a multidisciplinary process because the disease can potentially involve almost every organ system. The treatment team may include otolaryngologists, neurologists, pulmonologists, nephrologists, and rheumatologists, as well as dermatologists or endocrinologists, depending on the case.

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Make the Diagnosis: Extreme Earache