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

D. Brady Pregerson, MD

Disclosures

December 11, 2019

Physical Examination and Workup

Upon physical examination, the patient is noted to be alert and calm. His initial vital signs include a temperature of 97.9°F (36.6°C), a blood pressure of 132/87 mm Hg, a heart rate of 124 beats/min, and a respiratory rate of 18 breaths/min. The head and neck examination is remarkable for an obviously erythematous and edematous left ear. The erythema and swelling involve the entire left auricle, with multiple overlying areas of superficial vesicles (Figure). The tympanic membrane is clear, with no erythema, exudates, or bulging. The oropharynx is clear.

Upon examination of his eyes, the patient is noted to have a left-beating nystagmus on rightward gaze. A subtle left facial droop and weakness are noted as well. The muscles of the forehead are also involved, in addition to the muscles around his eye and mouth. Otherwise, the cranial nerve evaluation findings are within normal limits.

The patient demonstrates normal strength in his extremities, with normal proprioception and sensation. The deep tendon reflexes are within normal limits. The remainder of the physical examination findings, including the cardiac and respiratory systems, are unremarkable.

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