?Turkey ear?: a diagnosis or a physical sign?

Conflicts of interest: none declared. Sir, A 74‐year‐old woman presented with swelling and redness of her left ear which had been present since the age of 15 years and which had been steadily progressing over the last few years (Fig. 1). It was of such great cosmetic significance to her that she always wore a head scarf and kept her hairstyle long to cover her left cheek and ear. This had the clinical appearance of ‘turkey ear’, previously described in lupus pernio.1 A skin biopsy, in 1996, had been consistent with sarcoidosis and had shown numerous epithelioid granulomas containing a few multinucleated giant cells throughout the dermis accompanied by a dense lymphoid infiltrate. No central necrosis of the granulomas was seen. No organisms were demonstrable by periodic acid–Schiff/Giemsa/Ziehl–Neelsen staining. Serum angiotensin‐converting enzyme level was normal. There had been little response to potent topical steroids, and thus she was referred to the Ear, Nose and Throat Department for palliative excision in 2001. Histology of the excised tissue showed noncaseating, naked, epithelioid granulomas with Langerhans‐type multinucleated giant cells in a fibrotic stroma, consistent with sarcoidosis.