An 80-year-old male patient, living in a rural area, ex-smoker and social drinker, HIV negative, was referred to the stomatology clinic complaining of lesions on the upper lip, soft and hard palate that had been presented for 9 months, producing severe pain in the affected regions.\nThe patient underwent two biopsies in other clinical settings with inconclusive results. On physical examination, the right side of the upper lip presented an erythematous swelling associated with a granulomatous ulceration of labial mucosa that extended to the hard palate and seemed to infiltrate to the nasal region [Figure –]. No skin involvement was observed. Cervical lymphadenopathy with inflammatory features as swelling, pain and firm consistency was noticed during palpation.\nThe clinical hypothesis of tuberculosis, histoplasmosis and SCC were investigated, and an incisional biopsy was performed under local anesthesia. The patient's medical history recorded no relevant data.\nThe microscopical study evidenced areas of intense diffuse inflammatory infiltrate, with organized areas in the form of granulomas. In addition, the presence of multinucleated giant cells was observed, and a descriptive diagnosis of nonspecific chronic inflammatory process was provided [Figure and ]. Regarding the clinical and histopathological information, the hypothesis of mucocutaneous leishmaniasis was raised, and IDRM test was requested, which confirmed the suspicion. The patient was referred to an infectious diseases specialist to start treatment with Glucantime® (N-methylglucamine antimoniate). The dosage used was 20 mg Sb5 (pentavalent antimonial) +/kg/day intravenously for 30 days. Complete remission of the lesions was observed post treatment and after a follow-up of 12 months the patient remained with no signs of the disease and just a minor cicatricial sequelae.
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.