Eosinophilic ulcer of the tongue: a rare and confusing clinical entity

Abstract

Eosinophilic ulcers are rare, benign, reactive and often self-limiting lesions of the oral cavity. Although the aetiology is not clear, trauma is believed to play a role in their development. Clinically, the lesion manifests as an isolated ulcer, with raised, indurated borders and a yellow fibrinous floor; because of its long duration it often leads to the suspicion of squamous cell carcinoma. Although the ulcer is benign in nature, a biopsy is necessary to rule out malignancy. Histopathologically, the ulcer is characterised by the presence of dense inflammatory infiltrate extending into the deeper muscle layers with sheets of lymphocytes intermixed with eosinophils. This is a case report of a 65-year-old woman with an eosinophilic ulcer on the lateral border of the tongue. The ulcer healed rapidly after an incisional biopsy and topical steroid application. The final diagnosis was achieved following clinical and histopathological examination.

Traumatic Ulcerative Granuloma with Stromal Eosinophilia: A Diagnostic Dilemma

“…It has been known by a number of terms, including eosinophilic ulcer, eosinophilic granuloma of the tongue, traumatic granuloma, atypical histiocytic granuloma and Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE). This entity was first described by the Italian physician, Antonio Riga in 1881, and subsequently published by F Fede in 1890, hence it is known as Riga-Fede disease or Cardarelli aphthae [5]. The pathogenesis of TUGSE is postulated that trauma causes ulceration which allows influx of microorganisms, toxins and foreign debris around the surrounding tissue.…”

Do not forget to consider eosinophilic ulcer of the tongue!

“…A wait-and-see approach can be used and surgical excision, cryosurgery, and topical/intralesional corticosteroids are options for persistent lesions [1][2][3][4] . Recurrence is rare but removal of possible triggers (behavioral modification, dental care) is also important.…”

“…EUT is a benign, self-limited entity, usually diagnosed during the 1 st year or between the 5 th and 7 th decades of life [1][2][3][4] . Most lesions are solitary, asymptomatic, and located on the tongue [1][2][3][4] .…”

“…EUT is a benign, self-limited entity, usually diagnosed during the 1 st year or between the 5 th and 7 th decades of life [1][2][3][4] . Most lesions are solitary, asymptomatic, and located on the tongue [1][2][3][4] . Local trauma (biting, deformed teeth) is one of the drivers for EUT [1][2][3][4] but is insufficient to explain lesion progression.…”

“…Most lesions are solitary, asymptomatic, and located on the tongue [1][2][3][4] . Local trauma (biting, deformed teeth) is one of the drivers for EUT [1][2][3][4] but is insufficient to explain lesion progression. (Behçet, pemphigus vulgaris, and systemic lupus erythematosus), infectious (HSV, syphilis, HIV), and malignant (squamous cell carcinoma) diseases.…”