LAUSR

PRESENTATION A 13-month-old boy presented with bilateral ear discharge. He had initially presented to his pediatrician 6 months earlier with a foul smelling odor from both ears. At that time, he had been swimming 2 to 3 times per week, and his pediatrician had treated him with otic drops for presumed otitis externa. After a month of continued symptoms, a culture of the discharge was sent for laboratory analysis and turned out to be negative. He was subsequently noted to have dried blood in the left external auditory canal (EAC), and he was referred to otolaryngology (ENT). On microscopic examination by ENT, thick white otorrhea was seen bilaterally and “granular” masses were noted to fill both EACs. The child had also developed a scalp rash six weeks prior to presentation, which the family treated with an over-the-counter topical oil for presumed cradle cap, without improvement. The parents also noticed development of a plaque on the child's palate over several weeks before presentation, which they described as having the appearance of a “piece of steak stuck there.” In addition to the ear findings, on physical examination he had a brown macular scalp rash with areas of crusting. His oral examination was significant for a 1.5 cm irregular mass arising from the left palate. His vital signs and physical examination were otherwise normal. He had no prior significant medical history. His development was