The patient, a 69-year-old woman, presented with a four-year history of recurrent cough, exertional dyspnea, and intermittent throat tightness that was repeatedly treated as a respiratory tract infection. Nine months before admission, she developed arthralgia of the knees and ankles and painful bilateral auricular swelling (A), followed by flaccid auricular deformity (B). She also had persistent pancytopenia despite vitamin B12 and folate supplementation, erythropoietin, and transfusions.
