A case of Ear Piercing complicated by Auricular Perichondrit
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A 14 year old female presented to the emergency department (ED) complaining of pain and swelling in her right pinna for two weeks after an ear piercing. Five days following the piercing, she noticed a swelling and redness that progressively worsened. Three days prior to her ED visit she noticed pus discharge. On physical examination, the patient had tenderness, edema, bulging of her right pinna and a fluid collection that meant abscess formation on the upper third of the helix (Figure 1). The left ear was unremarkable. Tympanic membranes and auditory meatus were normal. The oropharynx was clear and there was no cervical lymphadenopathy. The remainder of the physical examination was within normal limits. The initial white blood cell count was 13.1 × 109/L with 9 × 109/L neutrophils. She was seen in the ED by an otolaryngologist who did an initial incision and drainage removing 3cc of sero-purulent drainage by needle aspiration and the specimen was sent for culture. The patient was admitted to the pediatric floor and was started on Clindamycin and Cefazolin. After 2 days, final culture result of the aspirate was positive for Pseudomonas aeruginosa (Pansensitive) and the antibiotic was switched to Levofloxacin. There was gradual clinical improvement and the patient was discharged home on Levofloxacin for 4 weeks. During the weekly follow up she showed a complete resolution of the swelling and pain....