Eosinophilic Ulcer Mimicking Tongue Malignancy: A Case Report

Eosinophilic ulcer of the oral mucosa is a rare and benign condition that clinically mimics oral malignancy due to its alarming features such as indurated, everted margins and prolonged persistence. This case report discusses a 70-year-old female who presented with a chronic non-healing ulcer on the right lateral border of the tongue, which had been present for three months and caused discomfort during speech and mastication. Ultrasonography showed no neck lymph node involvement. A biopsy of the lesion demonstrated a dense eosinophilic infiltrate without evidence of malignancy. To confirm the diagnosis and ensure complete excision, a wide local excision with adequate margins was performed. Histopathological analysis of the excised tissue confirmed the diagnosis of eosinophilic ulcer, revealing stratified squamous epithelium with surface ulceration, a dense inflammatory infiltrate rich in eosinophils, neutrophils, and plasma cells, and no evidence of malignancy or epithelial dysplasia. Postoperative recovery was uneventful, with no recurrence noted during follow-up. Eosinophilic ulcers are commonly misdiagnosed due to their resemblance to malignant lesions. Although the aetiopathogenesis remains unclear, trauma is a suspected contributing factor. In this case report, an intricate tooth bite was identified as the contributing causative factor. Surgical excision is considered the treatment of choice, with excellent prognosis and low recurrence rates. This case emphasises the critical role of histopathological examination in differentiating benign ulcers from malignant lesions, thus preventing overtreatment. Eosinophilic ulcer should be considered in the differential diagnosis of chronic oral ulcers, especially when typical risk factors for malignancy are absent.