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Case Reports in Medicine
Volume 2015 (2015), Article ID 307868, 4 pages
http://dx.doi.org/10.1155/2015/307868
Case Report

Early Stage Relapsing Polychondritis Diagnosed by Nasal Septum Biopsy

1Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
2Department of Post-Graduate Education, Kameda Medical Center, Japan
3Division of Geriatrics, University of California, San Francisco, CA, USA
4Department of General Medicine, Kameda Medical Center, Japan
5Department of Rheumatology and Allergy, Kameda Medical Center, Japan

Received 1 November 2015; Accepted 20 December 2015

Academic Editor: Joaquim Mullol

Copyright © 2015 Takaaki Kobayashi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Relapsing polychondritis is a rare inflammation of cartilaginous tissues, the diagnosis of which is usually delayed by a mean period of 2.9 years from symptom onset. We present the case of a 36-year-old man with nasal pain and fever. Physical examination of the nose was grossly unremarkable, but there was significant tenderness of the nasal bridge. Acute sinusitis was initially diagnosed due to thickened left frontal sinus mucosa on computed tomography (CT); however, there was no improvement after antibiotic intake. Repeat CT showed edematous inflammation of the nasal septum; biopsy of this site demonstrated erosion and infiltration of lymphocytes, plasma cells, eosinophils, and neutrophils in the hyaline cartilage. Relapsing polychondritis was confirmed by the modified McAdam’s criteria and can be diagnosed at an early stage by nasal septum biopsy; it should be considered as a differential diagnosis in patients presenting with nasal symptoms alone or persistent sinus symptoms.