Punctate red opacifications detected by transillumination of the ear lobe

subacute bacterial endocarditis

• 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]