Auricular swelling and tenderness with multiple pulmonary nodules

A woman in her 40s presented with a one month history of swelling and tenderness of the ears (fig 1), along with pain in her palms and fingers, and mild chest tightness. She had no history of chronic infections or occupational exposures. On examination, both pinnae exhibited firm, nodular swelling with erythema, tenderness, and warmth. Tenderness was also noted in the metacarpophalangeal and phalangeal joints bilaterally. Audiometric and vestibular evaluations demonstrated no abnormalities. No murmurs, gallops, or adventitious breath sounds were detected on examination of the cardiac and respiratory systems. A chest CT (computed tomography) scan was performed, which revealed multiple pulmonary nodules and bilateral mediastinal lymphadenopathy (fig 2). Laboratory investigations revealed a negative Mantoux test and T-spot, with serum angiotensin converting enzyme and calcium levels within normal ranges. A biopsy of the ear tissue was recommended but the patient declined.