Written informed consent was obtained from the patient to
publish this report in accordance with the journal’s patient consent
policy
A 62-year-old woman visited our clinic due to redness of the right ear
since the previous day (Figure 1). Physical examination revealed a
slight fever (37.6°C), chills, and heat and tenderness on her right ear
and preauricular area. There were no blisters on, in or around the ear.
Otoscopy showed no abnormalities of the external auditory canal or
tympanic membrane. Blood tests showed an elevated white blood cell count
(11,600 cells/µL). Therefore, unilateral ear erysipelas was diagnosed.
After intravenous amoxicillin for 7 days, the redness on the right ear
and preauricular area disappeared.
When redness of the auricle is present, the main differential diagnoses
are erysipelas, Ramsay-Hunt syndrome, relapsing polychondritis, and
chilblain lupus. In order to differentiate between them, it is necessary
to ascertain whether the redness is unilateral or bilateral, and whether
blisters, or tenderness are present.
The auricle has no deeper dermis and subcutaneous tissue. As the
inflammation involved epidermis and superficial lymphatics, the lesion
was diagnosed as erysipelas rather than cellulitis. The feature is
called Milian’s ear sign [1]. The pathogenesis of red ears can be
inferred by careful anatomical observation. Making the correct diagnosis
is important because the treatment and prognosis vary according to the
cause.
Reference
[1] Madke B, Nayak C. Eponymous signs in dermatology. Indian
Dermatol Online J. 2012 Sep; 3(3): 159-165.