Traumatic ulcerative granuloma with stromal eosinophilia. A case report and short literature review.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is considered to be a benign, reactive and self-limiting lesion. It is known under a variety of names including traumatic granuloma of the tongue, eosinophilic ulcer of the oral mucosa, ulcerated granuloma eosinophilicum of the tongue etc. [1]. It can be diagnosed at any age, but most commonly it is found as a rapidly developing lesion in the 5th decade of life. The same entity in infants and neonates is called Riga-Fede disease as it was first clinically described in 1881 by Riga and then histologically in 1890 by Fede [1, 2]. The main theory of TUGSE origin is matched with trauma, however the injury is identified in less than 50% of cases [3]. Clinically TUGSE is manifesting as an ulcer with elevated and indurated margins. It occurs mainly on the dorsal or lateral surface of the tongue, but other areas of the mouth can also be involved, including the buccal mucosa, vestibular mucosa or gingiva. This features along with rather quick development can clinically mimic squamous cell carcinoma. And due to threatening symptoms, it warrants a biopsy or excision [4]. There has been described also a case of TUGSE which was misdiagnosed as a primary syphilitic chancre on clinical grounds without serological confirmation and treated with a high dose benzathine penicillin [1]. The ulceration is causing a mild to severe pain. It persists for several weeks or months and heals without any treatment. Rapid healing after a biopsy or excision has also been reported.