Petrified Ears: Benchmark for a Systemic Disease

Abstract

Calcification of the auricular cartilage termed as "petrified ears" is a rare condition characterized by stiffness of auricular cartilages making them non-malleable and unable to get folded. Though appearing as an insignificant finding, it may be manifestation of an underlying systemic condition with masked systemic deteriorations. We present here report of a patient who presented with petrified ears and was found to have alkaptonuria.Our patient, a 40-year-old male, presented with three-years' history of progressive stiffness of ear pinna, two-years' history of off and on swelling of knees and one-year history of discoloration of skin over thumb, index, and middle fingers in both hands. He also had a lifelong history of darkening of urine. On examination, he had non-foldable, thickened, firm pinna with a few palpable hard papules and hyperpigmentation of overlying skin (Figure 1a, 1b). The ulnar borders of hands and fingers showed bluish-grey hyperkeratotic plaques of variable sizes (Figure 1c, 1d). He had wasted right leg with atrophy of overlying skin and right sided pes cavus (Figure 1e). Crepitus was positive in both knees and straight leg raising was normal. He had no tenderness over spine. His hemoglobin was 11.9 g/dL (normal: ≥13 mg/dL) and total leucocyte count was slightly low (3.5x10 9 /L; normal: 5-11x10 9 /L), however, platelet count, thyroid function tests, plasma glucose, serum calcium, parathyroid hormone, and vitamin D 3 levels, and urine routine examination were normal. On urine visual examination,