A Case of Pediatric Red Ear Syndrome Misidentified as Polychondritis

Red ear syndrome (RES) is a rare condition characterized by recurrent episodes of ear redness and burning pain. It is more commonly reported in adults, with pediatric cases being uncommon and often misdiagnosed.

A 14-year-old boy presented with a five-year history of recurrent severe left ear pain and erythema, initially misdiagnosed and treated as relapsing polychondritis (RP). The patient's symptoms began five years ago with sudden burning pain over the ear, radiating to the cheek. Episodes ranged from 10 minutes to six hours and sometimes involved constant aching. Attacks occurred in clusters lasting up to four months.

Despite various immunosuppressive treatments—including corticosteroids, pregabalin, dapsone (discontinued due to allergy), Imuran, colchicine, tocilizumab, and adalimumab—his symptoms persisted and worsened, leading to frequent school absences.

Upon reevaluation, physical examination revealed isolated unilateral auricular erythema and burning sensation, with no neurological deficits. Investigations showed elevated CRP and ESR but a negative autoimmune workup and normal MRI. Based on clinical features and the exclusion of other causes, a diagnosis of idiopathic respiratory eosinophilia syndrome (RES) was made.

The patient was started on ibuprofen, a tricyclic antidepressant, and a calcium channel blocker. Over the following months, he experienced a marked reduction in attack frequency and intensity, with complete resolution by the 3-month follow-up and sustained remission through the one-year mark.

This case highlights the importance of recognizing respiratory distress syndrome (RDS) in children to avoid misdiagnosis and inappropriate treatment. There is a need for greater awareness and research into effective therapies.

(Source:Case reports in pediatrics vol. 2025 6464822. 20 Jan. 2025, doi:10.1155/crpe/6464822;https://onlinelibrary.wiley.com/doi/full/10.1155/crpe/6464822)