A Case of Polychondritis in a Patient with Behçet's Disease
A 40-year-old man was referred to our hospital for further evaluation of his fever, oral ulcers and skin rashes that had lasted for 10 days. He had previously suffered from intermittent oral ulceration and uveitis that had been treated with oral prednisolone and intraocular injections of triamcinolone at another hospital 1 year prior to this admission.\nOn the physical examination, his blood pressure was 130/80 mmHg, the pulse rate was 80 per minute and the body temperature was 38.4℃. He had conjunctival injections in both eyes and several aphthous ulcers on the tongue () and buccal mucosa. A small round ulcer with tenderness was found on the penile root (). Several round erythematous skin lesions were present on the chest and thigh (). His left knee joint was swollen () and tender, and needle aspiration revealed turbid inflammatory synovial fluid.\nThe laboratory findings were as follows: hemoglobin 14.8 g/dL, white blood cell count 10,400/µL, platelet count 291,000/µL, erythrocyte sedimentation rate 104 mm/hr and C-reactive protein 205 mg/L (normal range, 0~3.4 mg/L). The renal and liver function tests were normal and the tests for rheumatoid factor and antinuclear antibody were negative. The urinalysis was normal and no microorganisms were grown on both the blood and urine cultures. His chest radiography showed no abnormal findings and mild splenomegaly was observed on abdominal sonography. Gastroduodenoscopy revealed a gastric ulcer and no ileocecal lesion was found on colonoscopy examination. Skin biopsy was performed and the histologic examination showed perivascular mononuclear cell infiltrations, extravasation of the red blood cells and fibrinoid necrosis of the blood vessel walls; all of these findings were compatible with cutaneous vasculitis combined with BD ().\nOn the 5th day of admission, both ear auricles became swollen, red and tender (). He remembered having a similar auricular inflammation 2 years ago that had improved after taking non-steroidal anti-inflammatory drugs. After he was administered with colchicine 1.2 mg/day and prednisolone 30 mg/day, his clinical symptoms improved and he was discharged on the tenth day of admission.