Case Report: Traumatic Ulcerative Granuloma With Stromal Eosinophilia

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE), also called Eosinophilic ulcer, is an inflammatory disease characterized by a benign course, and its onset is associated with mechanical trauma in mouth. It can last several weeks or even a year and easily misdiagnosed as oral squamous cell carcinoma and overtreated. The patient is an 81 years old woman. Chief complaint: a mass of the right tongue with pain for 1 month. Physical examination: a round ulcer with a diameter of 8mm can be seen in the middle of the right tongue abdomen, with a central granular protrusion covered with yellow pseudomembrane. The ulcer boundary was clear, the edge was white, touched hard, and the surrounding tissue was infiltrated. Besides, residual roots of teeth 41, 43, 44, 45, 46 were visible, with sharp edges. Her laboratory tests were negative and pathological result was ulceration of right tongue with active eosinophilic hyperplasia. Management strategies: removed residual roots of teeth, gargled with chlorhexidine and topical applied with triamcinolone. Outcomes: two weeks later, the ulcer was completely healed. TUGSE is relatively rare in clinical practice. It has unique clinical and pathological manifestations and some cases need to be differentiated from lymphoma. The principle of TUGSE treatment is to avoid overtreatment. We need to first remove the traumatic factors and use topical medication, then do biopsy if necessary and take regular follow-up observation for every patient who diagnosed as TUGSE.