A 25-year-old lady came in complaining of severe pain in her right ear. She got her ear pierced 3 days before the presentation, and it had become sensitive 2 days afterwards.
The sensitivity and accompanying throbbing discomfort were becoming steadily worse. The patient, who had previously had her ears pierced, denied having a fever, chills, or recently traveling abroad.
She was quite clean since she showered often and went to the gym often. A red, swollen ear was palpable during the physical examination (FIGURE).
Everything save the earlobe was swelled on the auricle. It was also seen that the helical puncture site was discharging purulent material.
Perichondritis of the auricle is the diagnosis.
Inflammation of the connective tissue around the ear cartilage is called auricular perichondritis. Possible contributors include infections and autoimmune reactions.
Involvement of the underlying cartilage is possible as well. Sparing the earlobe, which lacks cartilage, is a valuable clinical clue for the diagnosis of auricular perichondritis.
Bilateral involvement is frequent for autoimmune-related conditions. Typically, purulent leakage from a wound indicates an infectious etiology.
Although ear piercings are a leading cause of perichondritis, it may also develop after experiencing even moderate trauma, as a result of surgery, or for no apparent reason at all. Causes are often found via investigating the past thoroughly.
In this particular instance, the patient reported that she had been her ear pierced by a stranger at a mall kiosk using an uncapped piercing gun.
Since the shearing damage to the perichondrium caused by a piercing gun is considered to predispose to infection, piercing with a sterile straight needle would have been preferred and less likely to be linked with subsequent infection.
Differential: Early diagnosis is crucial.
Erysipelas, relapsing polychondritis, and auricular perichondritis are all possible causes of an irritated and inflamed ear. Intense, well defined erythema is a hallmark of erysipelas, a bacterial illness that spreads through the lymphatic system.
The face and lower legs are common sites for erysipelas outbreaks. Pseudomonal infection is a possibility following a piercing or traumatic injury that results in infection.
2-5 Ear deformity and rapid infection spread if left untreated. Although relapsing polychondritis has a similar pattern of inflammation, it more often affects both ears, in addition to the eyes and joints.
Avoiding unsightly deformity requires prompt medical attention.
Because Pseudomonas aeruginosa seems to have a specific predilection for injured cartilage, the timing of the response in our patient made infection clear.
The recommended dosage of ciprofloxacin is 500 mg twice day. Infected piercing sites and auricular perichondritis owing to pseudomonal infection will not react to oral cephalosporin, penicillin.
Or erythromycin, however these antibiotics are effective against many other types of skin infections. Reason being, Pseudomonas are less likely to be covered by these drugs than Staphylococci or other bacteria more often linked to skin diseases.
Disfigurement and time lost during treatment with an antibiotic like amoxicillin and clavulanic acid or oral cephalexin are real concerns.
In cases with fluctuancy, surgical procedures such as incision and drainage or even debridement may be required.
When severe infection causes necrosis and liquefaction of cartilage, therapy is challenging and may result in permanent deformity.
Treatment based on immediate observation and experience is the current gold standard.6 Our patient was given a 10-day regimen of 500 mg of ciprofloxacin to be taken every 12 hours. Within 2 days, she felt better, and the infection completely cleared up.
