Relapsing polychondritis — SCE Rheumatology MCQ

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ModerateVasculitisRelapsing polychondritisSCE Rheumatology

A 58-year-old man has recurrent painful swelling of both ears sparing the lobules, nasal bridge tenderness and hoarseness. ESR is 67 mm/hour. Audiology shows sensorineural hearing loss. There is no purulent discharge or trauma. What is the most likely diagnosis?

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Correct answer: C — Relapsing polychondritis

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

Relapsing polychondritis is best because recurrent auricular chondritis sparing the lobule with nasal and airway cartilage involvement suggests relapsing polychondritis. A is less suitable because sarcoidosis can affect ENT but cartilage inflammation is less typical; B is less suitable because GPA can affect ENT but does not classically spare the ear lobule in recurrent chondritis; D is less suitable because cellulitis usually affects skin including the lobule and is infectious; E is less suitable because gouty tophi are nodular urate deposits rather than diffuse chondritis. Clinical pearl: airway involvement is the dangerous complication to assess in relapsing polychondritis.

Reference: Oxford Textbook of Rheumatology