Differential Diagnosis

• Single most likely diagnosis
  • Infected ear piercing with possible perichondritis or cellulitis: The patient presents with an embedded earring, localized swelling, pain, and discharge, which are all indicative of an infection at the site of the ear piercing. The presence of systemic symptoms such as fever, dizziness, and fatigue further supports the diagnosis of an infection. The history of a recent ear piercing and the physical examination findings make this the most likely diagnosis.
• Other Likely diagnoses
  • Otitis externa: The evidence of discharge bilaterally in the external ear canals and the patient's symptoms of a blocked sensation in the ears, reduced hearing, and tinnitus could be indicative of otitis externa, especially given the recent history of an ear piercing and possible trauma to the ear canal.
  • Mastoiditis: Although less common, the symptoms of fever, hearing loss, and tinnitus, combined with the history of a recent infection (lingering flu-like symptoms), could suggest mastoiditis, particularly if the infection has spread beyond the external ear.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Meningitis: The presence of fever, dizziness, and fatigue, along with symptoms that could indicate increased intracranial pressure (such as hearing loss and tinnitus), necessitates consideration of meningitis, especially in the context of an infection. Although the lack of specific symptoms like neck stiffness and severe headache makes it less likely, it is a diagnosis that cannot be missed due to its high mortality rate if untreated.
  • Sepsis: Given the systemic symptoms of fever, dizziness, fatigue, and the presence of a localized infection, sepsis should be considered, especially if the patient's condition worsens or if there are signs of organ dysfunction.
• Rare diagnoses
  • Relapsing polychondritis: This is a rare autoimmune disorder that could present with ear symptoms, including pain, swelling, and possible hearing loss, especially if the cartilage of the ear is involved. However, it would be an unusual diagnosis given the context of a recent ear piercing.
  • Necrotizing otitis externa: This is a rare but serious infection of the external ear that can occur, especially in diabetic or immunocompromised patients. It presents with severe pain and could lead to significant complications if not recognized and treated promptly.