A 54-year-old man presents with significant eye pain. On further investigation, he recalls multiple episodes of sinusitis. On physical examination, he is noted to have a saddle-nose deformity, a tender, erythematous, and swollen ear, and mild inspiratory stridor. On eye examination, the patient has evidence of scleritis.
What is the most likely diagnosis?
A. SarcoidosisRelapsing polychondritis. (B) Syphilis, granulomatosis with polyangiitis (GPA), and relapsing polychondritis can all present with saddle-nose deformity. The distinguishing feature of relapsing polychondritis is the ear involvement with damage to the auricular cartilage. (C) GPA can present with scleritis, recurrent sinusitis, and pulmonary involvement, but the pulmonary involvement is much more likely to affect lower airways. The patient’s inspiratory stridor is more suggestive of upper airway involvement such as tracheobronchomalacia, a life-threatening complication of relapsing polychondritis. (A) Sarcoidosis is less likely to present with the above combination of cartilage inflammation of the ear and scleritis. (D) Polyarteritis nodosa is a vasculitis that presents with generalized symptoms (fatigue, weakness, etc.) and skin rash (ulcerations, palpable purpura, livedo reticularis, etc.).