A Rare Case of Chondritis in a Patient with Ulcerative Colitis in Remission: A Case Report

Abstract

Purpose: 67-year-old Caucasian male with 10 year history of ulcerative colitis presented to the hospital with 10 day history of left ear swelling, erythema and pain. He was treated with 10 days of antibiotics, for presumed cellulitis, but failed to improve. He did not report any diarrhea or bloody bowel movements. His ulcerative colitis has been stable on Asacol 800 mg TID for the last one year. Physical examination showed stable vital signs except temperature of 99.9. Left ear pinna was erythematous, swollen, warm and tender. No discharge from ear. No adenopathy. Examination otherwise was negative. Laboratory studies showed no leukocytosis, normal biochemistry and urinalysis. Antinuclear antibodies, rheumatoid factor were negative. Maxillofacial CT with intravenous contrast demonstrated normal external and internal ear structures bilaterally without bony erosion and with mild soft tissue swelling of the left ear. After a week of parenteral antibiotics and attempted incision/drainage, his symptoms worsened. Repeat Maxillofacial CT with IV contrast showed moderate soft tissue swelling of the pinna and soft tissues adjacent to the left ear, external auditory canal. Wound cultures were negative. Subsequently he developed two red, raised, warm, tender areas on left forearm suggestive of erythema nodosum. He was started on dexamethasone with marked improvement in his symptoms. Antibiotics were discontinued. He was discharged on dexamethasone taper with complete resolution of his symptoms within 2 weeks. Discussion: Our patient had a rare case of chondritis associated with ulcerative colitis. At time of presentation, his ulcerative colitis was in remission. Early recognition and treatment is crucial and can be treated as an outpatient and prevent complications associated with hospital stay. With treatment, we can also prevent progression to polychondritis. To our knowledge we are reporting first case of chondritis in a patient with ulcerative colitis in remission. In literature, we found polychondritis and ulcerative colitis by Ascuncion AM et al, in which the patient had ulcerative colitis exacerbation.Figure: Pretreatment picture.