A 25-year-old woman presented with severe pain in her right ear. Three days earlier, she had her ear pierced, and sensitivity began two days afterward, accompanied by worsening throbbing discomfort. Despite the pain, she reported no fever, chills, or recent travel history.
Clinical Findings:
Upon examination, everything on the auricle except the earlobe was swollen. The helical puncture site showed purulent discharge.
Diagnosis:
Auricular perichondritis—an inflammation of the connective tissue surrounding the ear cartilage—was diagnosed. This condition often spares the earlobe, which lacks cartilage, making it a critical clue for diagnosis.
About Auricular Perichondritis
Auricular perichondritis can result from infections, autoimmune reactions, or trauma. In severe cases, the underlying cartilage may become involved.
- Infectious Causes: Often indicated by purulent discharge, infections commonly follow trauma such as piercings or surgeries.
- Autoimmune Causes: These are more likely to involve both ears and may affect other areas like the eyes and joints.
Case Background:
The patient revealed that her ear was pierced by a stranger at a mall kiosk using an uncapped piercing gun—a method that can cause shearing damage to the perichondrium and predispose the area to infection. A sterile straight needle would have been a safer alternative.
Differential Diagnosis:
- Erysipelas: A bacterial infection marked by intense erythema that spreads via lymphatic pathways. Common on the face and legs.
- Relapsing Polychondritis: A systemic autoimmune condition often affecting both ears along with joints and eyes.
- Auricular Perichondritis: Typically presents with localized purulent discharge and inflammation after trauma or piercing.
Pseudomonas aeruginosa, known to target injured cartilage, was identified as the likely pathogen in this case.