BMJ Case Reports 2014; doi:10.1136/bcr-2013-202670

Fever of unknown origin in a patient with red ears: relapsing polychondritis

  1. Ruben Garcia
  1. Department of Medicina 1, Hospital do Espírito Santo de Évora, Evora, Portugal
  1. Correspondence to Dr Juliana Nunes Avila, junuavila{at}


Relapsing polychondritis (RP) is a rare autoimmune disease that affects cartilage and multiple organ system. We describe a case of RP presenting with fever, conjunctivitis and inflammatory signs of the right knee. Infectious and neoplastic diseases were excluded by imaging and laboratory examinations. After 17 days of admission the patient reported coughing and odynophagia, and, a physical examination showed red ears. Otorhinolaryngological examination demonstrated arytenoid chondritis. RP was diagnosed based on four McAdam’s criteria. The patient was medicated with oral prednisone, and a positive clinical response was noted. Severe disease may require high doses of corticosteroids or immunosuppressive agents and the biological treatment may be beneficial. Beginning manifestations, such as fever, are often unspecific, leading to RP misdiagnosis. In this case, close attention to the patient’s clinical history and a detailed physical examination were fundamental in concluding the correct diagnosis, and consequently beginning the appropriate medication.

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