Jasmin is a 38-year-old receptionist who presents with right otalgia and tender posterior cervical lymphadenopathy.

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<p>Jasmin is a 38-year-old receptionist who presents with right otalgia and tender posterior cervical lymphadenopathy.</p><p>Jasmin has rheumatoid arthritis and has been on weekly etanercept (50mg/mL SC injection) for six years.</p><p>On examination, she has a fever of 38.5°C and a bulging erythematous right tympanic membrane.</p><p>Jasmin is prescribed amoxicillin 500mg tds for otitis media and advised to discontinue etanercept until well. She is told to re-present if her symptoms do not respond or if they progress.</p><p>Four days later, she returns with drainage from her right ear. She also reports suddenly being unable to raise her eyebrow, wrinkle her forehead or raise her lip.</p><p>The pertinent examination findings, which are new compared with the previous visit, are pictured.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.