Rebecca E. Galante, MD

The initial complaint of a 79-year-old woman was of mild headache, neck pain, and sore throat. She had a history of hypertension, diabetes mellitus, and heavy cigarette smoking. Examination by an otolaryngologist, which included laryngoscopy, revealed no abnormalities. Three weeks later, the patient's throat and neck pain became more severe. She had no arthralgias, visual loss, fever, or worsening head pain.

For 2 days, an 80-year-old woman had left ear pain and a rash around the ear canal and pinna. She also complained of pain and small papules in the back of her pharynx on the left side. She had no fever or chills and no rash elsewhere on her body. She denied drainage from the ear and previous ear infections or skin eruptions. Several years earlier, she had undergone surgery and chemotherapy for lymphoma but had been well since then.