Painful wart in the ear?

A 25-year-old man was admitted to ENT ward with complaints of acute onset pain in the left ear of two days duration and was referred to our department for a small lesion in the same ear assuming it to be a wart. On examination, solitary, shiny, bluish-white tender papule was seen on the concha of the left ear [Figure 1]. On closer examination, it was found to be a tick that disengaged after instillation of a few drops of surgical spirit over it [Figure 2]. The patient had instantaneous relief of his pain and bite site healed with topical antibiotic without any sequelae. The patient was followed-up for one month with no evidence of any systemic illness suggestive of vector-borne illness.

Figure 1

Live tick attached to the left concha

Figure 2

Closer view of the tick

DISCUSSION

Ticks are blood-sucking ectoparasites of animals, humans being incidental hosts. Pain experienced by the patient after tick bite is often severe and drives them to seek immediate medical attention, although sometimes there may be a delay. There was a report of a 23-year-old girl presenting with a one month history of embedded tick near the clavicle.[1] Ticks may attach themselves anywhere on the body. Without a closer look, they may be mistaken for something else. Ashique reported a case in which the tick was mistaken for a mole by the patient and in our case for a wart.[2] Clinical manifestations are varied such as pain, local allergic response, granuloma formation, pruritic papules, or papular urticaria.[3] Ticks could be vectors for diseases such as Lyme disease, tick-borne-encephalitis, and tick-borne lymphadenopathy.

Various methods have been suggested for tick removal such as application of iodine, ether, chloroform, petrol, and kerosene. Removal of the tick by holding it as close to the skin as possible with a fine curved forceps seems to be the most preferred method.[4] Recently, cryotherapy has also been tried with success.[4] Persons who have undergone tick removal should be monitored for up to 30 days for signs and symptoms of tick-borne diseases.