Bullous myringitis with interstitial pneumonia

How it presents

The shape of this presentation is ear pain that begins late in a week of fever, headache, sore throat and a mildly productive cough.

The described case is a 12-year-old male with a 1-week history of fever, headache, sore throat and a mildly productive cough, who also began having ear pain yesterday. On examination he does not appear to be toxic, with a temperature of 37.8 C (100.0 F). Examination of his ears shows a bulla on the right tympanic membrane, as well as mild to moderate erythema of the posterior pharynx. The neck is supple. The lungs have a few scattered crackles. The remainder of the examination is unremarkable.

Every finding in that list is quiet on its own: he is not toxic, the fever is low at 37.8 C, the pharynx is only mildly to moderately red, the neck is supple and the chest has a few scattered crackles rather than signs over one lobe. The ear finding and the chest finding arrive together, a day apart.