A 24-Year-Old Man With Ear Pain, Dizziness, and a Rash

D. Brady Pregerson, MD


December 11, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 24-year-old man who was recently diagnosed with HIV presents to the emergency department with a chief complaint of left ear pain that has lasted for the past 24 hours. Yesterday, the patient visited his primary care provider and was informed that his ear appeared normal, without any evidence of infection. However, he now reports that the pain is significantly more intense, and his ear is now red and swollen. He also states that he has vomited twice today and he feels "dizzy." He describes the dizziness as a feeling that the room is spinning, and it is made worse with any movement of his head.

In addition, the patient states that his hearing in his left ear is muffled compared with that in his right ear. He denies experiencing any fever, chills, headache, or generalized weakness. He also denies scratching his ear or placing foreign bodies (such as cotton swabs) into his ear. He has no history of trauma. The patient has no known medical conditions other than HIV infection and no allergies. He has not yet started taking any medications for HIV or other conditions.


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