Teaching NeuroImage: Seizures as the Initial Symptom of Relapsing Polychondritis

A 41-year-old man presented with generalized tonic-clonic seizures. MRI revealed left subinsular and right frontal cortex lesions (Figure 1). CSF analysis showed 17 white cells/mm3 (lymphocytes 92%), normal protein, and glucose. The infection and autoimmune screening were negative. On day 3, bilateral auricles swelling and episcleritis emerged (Figure 2). Biopsy of left auricle revealed perivascular lymphocytic infiltration (Figure 2), consistent with relapsing polychondritis (RP). The patient’s symptoms improved after oral prednisolone.

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