Auricular chondritis associated with tuberculous lymphadenitis.

Abstract

An 85-year-old woman presented with a 3-week history of fever. At another hospital, treatment with cefditoren had been ineffective. 55 years earlier, she had been diagnosed with pulmonary tuberculosis and given a 2-year course of antituberculosis drugs, including isoniazid, streptomycin, and paraaminosalicylic acid. On physical examination, ulcerative inflammation involved the left auricle and completely spared the left earlobe (figure), which suggested chondritis rather than dermatitis. Tender left cervical lymphadenopathy was noticed (figure). Whole-body CT showed enlarged left cervical lymph nodes, stippled and nodular calcification in both lungs, and lymph node calcification in the mediastinum, which suggested old healed pulmonary tuberculosis. 18F-fluorodeoxyglucose (18F-FDG) PET/CT showed abnormal fluorodeoxyglucose accumulation in the left auricle and left cervical lymph nodes (figure) with no arthritis or vasculitis. Incisional biopsy specimens of the affected cervical lymph nodes showed epithelioid granulomatous inflammation with Langhans giant cells and caseous necrosis on haematoxylin and eosin stain, which were consistent with tuberculosis. Biopsy specimens of the cartilage and skin in the inflamed auricle identified chondritis with no granulomatous inflammation on haematoxylin and eosin stain. In both specimens, Ziehl Neelsen stain results, mycobacterial culture result, and Mycobacterium tuberculosis PCR were negative. Treatment with antituberculous drugs, including 2-month course of isoniazid (200 mg/day), rifampicin (450 mg/day), and ethambutol (500 mg/day), and 7-month course of isoniazid (200 mg/day) and rifampicin (450 mg/day), resolved fever, auricular chondritis, and cervical lymphadenitis. At the 2-year follow-up, the patient did not have recurrence of lymphadenitis and auricular chondritis, and chest x-ray showed no recurrence of pulmonary tuberculosis.