Manzoor Ul Hasan, Haroon T S, Ijaz Hussain.
Diabetes Mellitus and Relapsing Polychondritis A case report.
J Pak Assoc Derma Jan ;8(3):27-9.

Relapsing polychondritis (RP) is a rare, non-infective condition of undetermined cause, characterized by focal inflammatory destruction of the cartilage accompanied by fibroblastic regeneration. The disease has been seen in association with other autoimmune disorders. Diabetes Mellitus (DM) has not been yet reported as its association. This is a case study of a patient with RP in whom non insulin Dependent Diabetes Mellitus (NIDDM) was present for the last six years.

CASE REPORT : A 50-year old man, presented at Dermatology outpatient clinic, King Edward Medical College/Mayo Hospital, with a two week history of pain, swelling and redness of both ears alongwith mild constitutional symptoms. He had a similar attack about four weeks ago. He also complained of intermittent arthralgias in the small joints of hands and feet and soreness in the eyes for the last one year. There was no history of any nasal, audiovestibular or respiratory symptoms. The patient was known diabetic for the last six years and well controlled on glibenclamide. The abnormal physical findings included red, swollen, and tender pinna bilaterally, sparing the earlobes; scleritis and episcleritis in both eyes and red swollen proximal interphalangeal joints of hands and feet, No other abnormal systemic sign was found on physical examination. Histopathology form left ear revealed features of chondrolysis with perichondritis while the overlying dermis was normal. Direct immunofluorescence and urinary mucopolysaccharides could not be done because of unavailability. Other abnormal laboratory tests included a leucocyte count of 18,000/mm 3, an ESR of 57 mm/first hr, a nonspecific elevation in serum 1gM level and positive rheumatoid arthritis factor whereas serum was negative for antinuclear antibodies (ANA). The fasting and 2 hrs postprandial blood sugar values at the time of presentation were 109 and 136 mg/ dl respectively. Radiological examination of the joints of hands feet was normal. The patient responded favourably to 40 mg of oral prednisolone daily and was later maintained on 15 mg on alternate days.The patient is in complete remission at the time of writing.

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