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Auricular chondritis as a suggestion of connective tissue disease
Abstract
Background. Relapsing polychondritis is a rarely recognized systemic disease, characterized by recurrent inflammation of cartilaginous structures of external ear, nose, larynx and other. It is an autoimmune disease. Objectives. The aim of this paper is to show that such noticeable symptoms as auricular chondritis may be a very important indication of a connective tissue disease. Material and methods. We describe two typical cases with inflammation of the cartilage tissue of the external ear. Results. The knowledge of symptomatology enables early detection of the disease. Conclusion. Early treatment allows avoidance of serious complications like aortitis or laryngitis.
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Relapsing polychondritis (RP) is a rare, multisystem, autoimmune disorder characterized by recurrent inflammation and destruction of the cartilage tissue of the external ear, nose, larynx, trachea, major bronchi and peripheral joints. RP can also involve other proteoglycan-rich structures, such as the eye, heart, blood vessels, inner ear and kidney. The diagnosis is made on the basis of modified Mc Adam criteria including chondritis in two of three sites (auricular, nasal, laryngotracheal) or one of those sites and two other features, including ocular inflammation, audiovestibular damage, or seronegative inflammatory arthritis. A biopsy is not recommended in most cases. We describe the case history of a 76-year-old male with multisymptomatic RP including SND and MR successfully treated in our department.
Aortic regurgitation associated with relapsing polychondritis usually occurs late in the disease as a result of aortic root dilatation. A case where aortic regurgitation occurred early and was due to cusp rupture with a normal aortic root is reported. The patient required urgent aortic valve replacement within six weeks of developing a murmur despite apparent control of inflammation with immunosuppressive treatment. The possibility of cusp rupture with sudden haemodynamic deterioration should be considered in patients with relapsing polychondritis who develop aortic regurgitation.
We describe a patient with relapsing polychondritis in whom aortic valve inflammation developed 3 years after diagnosis, when the polychondritis had been in apparent remission for an extended period of time. Infection and cardiac involvement can be significant complications of relapsing polychondritis. Recommendations for monitoring and treatment of patients with this disease are discussed.