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Granulomatous cheilitis with gingival enlargement
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A 20 yr old man presented to the Dermatology Outpatient Department of Dr. Ram Manohar Lohia Hospital, New Delhi, India, in July 2014 with asymptomatic slowly progressive swelling of the upper lip for six months. The swelling was episodic initially but became persistent later. The patient did not have any systemic (including gastrointestinal) complaint. There was no history of prior intake of any drug. On examination, the upper lip was swollen and firm and non-tender on palpation. There was associated swelling of the gingiva which was firm in consistency (Fig. A). There was no bleeding on probing. Rest of the oral examination was normal. There was no evidence of facial weakness or lymphadenopathy. Tests for tuberculosis were negative. Punch biopsy from the lip showed non-caseating granulomas composed of epithelioid cells, Langhans giant cells and lymphocytes (Fig. B & C). Similar findings were seen in biopsy taken from gingiva. Gingivectomy was done and the patient was started on intralesional triamcinolone injections (10 mg/ml) once in three weeks along with oral clofazimine 100 mg daily with improvement in swelling after three months (Fig. D & E). Clofazimine was continued for six months. The patient did not develop any recurrence in the one year of follow up.
- (A) Swelling of the upper lip with enlargement of the lower anterior gingiva (arrows). (B) Non-caseating epithelioid cell granulomas (arrows) stained with hematoxylin and eosin (H&E, ×100). (C) Granulomas composed of dense lymphocytic infiltrate (blue arrow) along with Langhans giant cells (pink arrow) (H&E, ×200). (D) Decrease in upper lip swelling with treatment. (E) Decrease in gingival swelling with treatment.
The presence of granulomatous cheilitis in combination with gingival enlargement is rare and is usually associated with Crohn's disease. Hence, gastrointestinal evaluation was done in this patient, which was negative. However, the oral manifestations may precede the diagnosis of inflammatory bowel disease by several years. It is, therefore, advised to keep such patients under follow up.
