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A 64-year-old man was referred to an eye clinic because of recurrent bilateral red eyes and lid swelling, which had started 14 months earlier. One or both eyes would become inflamed and stay so until he was given a short course of oral corticosteroids. He was being treated for allergic conjunctivitis, both topically and systemically, and he had been treated for one episode of iritis. Examination revealed an inflamed, swollen, and tender right ear and a red right eye (Panel A). The pinna of his ear was involved, but the earlobe was spared. There was no nasal deformity or inflammation. Ocular examination revealed diffuse conjunctivitis and episcleritis on the right side. There were old posterior synechiae between the lens and iris, indicating prior anterior uveitis (Panel B).
Laboratory evaluation revealed microhematuria, mild leukocytosis, anemia, and an elevated serum total protein level and Westergren sedimentation rate. The results of tests for rheumatoid factor and antinuclear antibodies and a serologic test for syphilis were normal. A diagnosis of relapsing polychondritis was made on the basis of the inflammation of the patient's ear and eye, his blood disorder, a history of aortic-valve dysfunction, and the nonspecific but abnormal laboratory values. The acute ocular and auricular inflammation resolved with oral corticosteroid treatment. Azathioprine was started, and the corticosteroids were tapered. The patient has been well, without a recurrence, for 16 months.
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