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A 59-year-old man with chronic obstructive pulmonary disease (COPD) presented with dyspnoea for 3 days. Physical examination revealed diffuse rhonchi over chest, and very hard, thick, deformed auricles except for the ear lobules, which were soft ( figure 1A ). Patient reported remote history of episodic pain and redness of his ears and nose, which improved with over-the-counter pain medicines. A radiograph of the ears showed calcification of the auricular cartilages ( figure 1B , white arrow). A complete blood count showed neutrophilic leucocytosis of 13.1x103 /[micro]L and chronic normocytic anaemia of 12.3g/dL. Inflammatory markers including erythrocyte sedimentation rate and C reactive protein, and renal and liver function tests were normal. Prior work-up was negative for antinuclear and antineutrophil cytoplasmic antibodies. A clinical diagnosis of relapsing polychondritis (RP) was made based on the reported history and...