A Case of Relapsing Polychondritis Mimicking Hemophagocytic Lymphohistiocytosis After Propionibacterium acnes Infection

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We describe a 69-year-old man who presented with a right sternocleidomastoid intramuscular abscess that grew Propionibacterium acnes. Despite initial improvement with antibiotics, he subsequently developed signs and symptoms fulfilling diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH)—fevers, cytopenias, hyperferritinemia, splenomegaly, and low natural killer cell activity. The patient improved spontaneously but at outpatient follow-up complained of erythema over the bridge of his nose as well as bilateral ear redness sparing the earlobes at which point relapsing polychondritis (RP) was diagnosed. Treatment with steroids and methotrexate resulted in complete symptom resolution. This is the first reported case of RP presenting after this particular infection and as a mimic of HLH. Diagnosis of RP is often delayed because of the heterogeneous and relapsing nature of symptoms. This case illustrates the importance of outpatient follow-up; RP criteria were not fulfilled for more than 2 months after initial presentation.

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