A 34-year-old male patient reported with swelling of face. The facial swelling was first noticed 13 years ago, which gradually increased in size followed by swelling of upper and lower lip. A physician had prescribed drugs, not known to the patient, which aggravated the swelling. Patient had discontinued the medication and did not report to the physician. The swelling gradually reduced without treatment but did not disappear completely. The patient avoided tamarind and raw mangoes as it seemed to aggravate the swelling. However, the swelling had started to increase in size over last six months. Medical history was non-contributory except for a six month-history of occasional constipation.\nClinical examination revealed diffuse swelling of lower third of face and gross enlargement of upper and lower lips []. The swelling was diffuse, non-tender and without bruit or pulsation. Angular cheilitis and spreading erythema were present near the right corner of mouth. Lymph node examination was unremarkable. On intraoral examination, multiple hyperplastic, swollen mucosal folds forming Cobble stone appearance in relation to right and left buccal mucosa was present [], with generalized bead like gingival hyperplasia on the labial and buccal aspects [] and palatal hyperplasia involving the rugae area were prominent []. Considering patients history and clinical examination, the clinical differential diagnoses included Crohn's disease, sarcoidosis and orofacial granulomatosis (OFG).\nHematological investigations revealed raised erythrocyte sedimentation rate ((ESR) 25 mm in 1st hour). Chest radiograph did not reveal anything significant. Incisional biopsy in relation to right and left buccal mucosa revealed oedematous superficial lamina propria with dilated lymphatic vessels. Lymphocytes were scattered diffusely and in clusters along with fibrous scattered aggregates of non-caseating granuloma []. The hematoxylin and eosin stained photomicrograph showing a parakeratinized stratified squamous epithelium along with the underlying granuloma formation under scanner view (5a) and low power view (5b and c). High power view shows scattered aggregates of non-caseating granuloma (5d and e), which are typically small consisting of macrophages, epitheloid cells surrounded by scattered lymphocytes and plasma cells (5f) suggestive of the granulomatous lesion.\nColonoscopy advised in consult with a gastroenterologist revealed scattered areas of inflammation and erythema involving cecum and ascending colon [] Further, multiple areas were biopsied which revealed numerous chronic inflammatory cells like lymphocytes and plasma cells indicating colitis.
A 40-year-old, generally healthy woman complained of persistent lip enlargement and sore that appeared after several days of fever and had been present for 2 months. At clinical examination, the left side of the upper lip appeared erythematous and distended, with overlying yellow crusting lesion extending to the wet line. No lymphadenopathy was associated (Fig. ). Giemsa-stained smears and culture were positive (Fig. ). PCR identified the parasite as L. major.