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Punctate red opacifications detected by transillumination of the ear lobe
    Differential Diagnosis[Top] [Nav]
subacute bacterial endocarditis
    Discussion -- not available online[Top] [Nav]
    Update Comments[Top] [Nav]
  • After reaching 1200, Libman stopped counting the number of SBE cases he'd seen during his career. I have unsuccessfully combed the literature looking for Libman's report of the earlobe sign. The closest I've come is the following comment:
    Sometimes the blood contains large phagocytic cells, varying in size between 10 and 80 micra. These macrophages, histiocytes or endothelial cells, as they have been variously termed, may dominate the blood picture and are helpful in confirming the diagnosis [of SBE]. But they are not usually present, nor are they pathognomonic of this disease. When present, they usually form 3 to 5 percent of the leucocytes but may go as high as 40 percent.
    [101]
  • Contains a number of other physical signs related to earlobes:
    • Stiff earlobe as a reliable sign of Addison disease, vs. calcified pinna, which is not.
    • Winking earlobe (especially on the right side) in tricuspid regurgitation is caused by large A waves.
    • Gouty tophi can occur in the earlobes. (Card HD-301 mentions tophi in the pinnae.)
    [103]
    Footnotes in Print Edition[Top] [Nav]
    (1) Clinical Diagnostic Pearls.
  Birnholz JC, Michelson PE. Flushing, NY: Medical Examination, 1971: 15,61.
    (2) Hematologic observations in bacterial endocarditis.
  Daland GA, et al.   J Lab Clin Med. 1956;48:827-845.
    (3) Facial Features of Neurologic Syndromes.
  Dyken PR, Miller MD. St. Louis: Mosby, 1980: 81.
    (4) Clinical Cardiology.
  Sokolow M, McIlroy MB. Los Altos, CA: Lange 1979: 43.   Amazon.com
    (5) Lecture Notes on Urology. 3d ed.
  Blandy J. Oxford: Blackwell, 1982.: 263.
    (6) Personal Communication.
    (7) Early and late cutaneous manifestations in Ixodes-borne borreliosis (erythema migrans borreliosis, Lyme borreliosis).
  Asbrink E, Hovmark A.   Ann N Y Acad Sci 1988;539:4-15.  Pubmed  Similars
    New References[Top] [Nav]

Libman spots
    101.Subacute Bacterial Endocarditis.
  Libman E, Friedberg CK. London: Oxford, 1941: 49, 51, 81-82.
    102.The appearance of histiocytes in the blood in subacute bacterial endocarditis.
  Engle RL, Koprowska I.   Am J Med. 1959:965-973.

Other earlobe findings
    103.The Art and Science of Bedside Diagnosis.
  Sapira JD. Baltimore: Urban & Schwarzenburg, 1990: 209.   Amazon.com
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:35 PDT on July 4, 2000.[Top]

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