An unusual case of oral traumatic ulcerative granuloma

Background Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an uncommon condition considered to be a benign, reactive lesion that usually affects the tongue. The exact pathogenesis is not clear. However, trauma has been found to be a contributing factor in a majority of cases. Here, we present an unusual case of TUGSE in an adult patient. Case Report A 26-year-old male patient was referred to the Kuwait University Dental Center with a painful lesion on the dorsal surface of the tongue that had been present for 7 months. On examination, a diffuse ulcerative proliferative lesion with erythematous borders was seen on the dorsal surface of the tongue. On palpation, the lesion was very tender and deep clefts were observed. After a week of prednisolone mouthwash, the patient felt that his pain had reduced and he was able to eat. Incisional biopsies showed partially ulcerated stratified squamous epithelium covered by fibrin. The underlying stroma was edematous and highly vascular with dense inflammatory infiltrate, the majority of which were eosinophils, histiocytes, and plasma cells. The inflammatory infiltrate extended into the underlying skeletal muscle. These features were suggestive of TUGSE. Immunohistochemical analysis showed positivity to T-cell markers CD-3 and CD-30; B-cell marker CD-20; and histiocyte marker CD-68, implying a mixed inflammatory infiltrate. On follow-up, the patient reported improvement but was concerned that the lesion has not healed completely. Conclusions Recognition of the lesion is important because it often mimics malignancy. However, traumatic granuloma is a self-limiting lesion that usually heals within 2 to 3 weeks.