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 Table of Contents  
THE CLINICAL PICTURE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 128-129

Bilateral red ears: Milian ear sign


Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India

Date of Submission22-Dec-2019
Date of Decision21-Jul-2020
Date of Acceptance11-Sep-2020
Date of Web Publication22-Jul-2021

Correspondence Address:
Dr. Abheek Sil
Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, 1, Khudiram Bose Sarani, Kolkata -700004, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/Pigmentinternational.Pigmentinternational_

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  Abstract 


Milian ear sign is a specific clinical finding that aides in differentiating erysipelas from facial cellulitis. The anatomical absence of subcutaneous tissue in pinna brings about this clinical distinction. Although bilateral Milian ear sign is rare, erysipelas should be considered when encountering patients presenting with red ears, among other differentials such as Ramsay-Hunt syndrome, relapsing polychondritis, auricular perichondritis, and red ear syndrome.

Keywords: Ear lobule, erysipelas, Milian ear sign


How to cite this article:
Chakraborty S, Bhanja DB, Sil A. Bilateral red ears: Milian ear sign. Pigment Int 2021;8:128-9

How to cite this URL:
Chakraborty S, Bhanja DB, Sil A. Bilateral red ears: Milian ear sign. Pigment Int [serial online] 2021 [cited 2021 Aug 3];8:128-9. Available from: https://www.pigmentinternational.com/text.asp?2021/8/2/128/322036



An otherwise healthy 43-year-old lady presented with a 3-day history of fever, facial rash, and painful swelling of both ears. She had no other complaints suggestive of any systemic involvement. Physical examination revealed a well-demarcated tender indurated, erythematous, and edematous swelling of both ears and face, sparing the forehead and chin [Figure 1]a and b. Laboratory investigation showed neutrophilic leucocytosis and elevated erythrocyte sedimentation rate. Antinuclear antibody testing was negative. Given the characteristic ear involvement (Milian ear sign), the patient was diagnosed with erysipelas. Complete resolution of symptoms was achieved within 10 days with systemic antibiotics (intravenous clindamycin).
Figure 1 (a and b) Erythematous and edematous swelling of both ears and face.

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Milian ear sign is a specific finding that differentiates erysipelas (bacterial infection of the dermis and upper subcutaneous tissue) from cellulitis (strictly an acute, subacute, or chronic inflammation of loose connective tissue)[1] The anatomical absence of deeper dermal and subcutaneous tissue in the pinna brings about this clinical distinction. However, current usage tends to regard erysipelas as a form of cellulitis rather than a distinct entity, so that the definition of cellulitis would include inflammation of dermal as well as subcutaneous tissue.[2]

Although erysipelas with bilateral Milian ear sign is rare,[1] it should be considered when encountering patients presenting with tender red ears, among other differentials such as Ramsay-Hunt syndrome (herpes zoster oticus), relapsing polychondritis (severe, episodic inflammatory condition involving cartilaginous structures), auricular perichondritis (infection of connective tissue of the ear that typically spares the lobule), and red ear syndrome (erythema and burning sensation of external ear as a component of trigeminal autonomic cephalgia).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Suzuki K, Otsuka H. Bilateral Milian’s ear sign of erysipelas. Intern Med 2017;56:2381-2.  Back to cited text no. 1
    
2.
Sugimoto H, Furukawa K. Milian’s ear sign: erysipelas. IDCases 2018;14:e00449.  Back to cited text no. 2
    


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