An 8 month-old infant boy with cerebral palsy presented with a large
exophytic lesion under the tongue with erythema surrounding a removable,
fibrinopurulent membrane and granulation tissue proliferation present
for several weeks (Fig. 1). He was unable to suckle for
feeding. Laboratory tests were normal. Biopsy was suggestive of
distinctive ulcerative traumatic granuloma with stromal eosinophilia
(Riga-Fede disease). Contact of the tongue with the sharp, newly erupted
mandibular teeth was apparent. Grinding the teeth edges and covering
with resin resulted in rapid resolution within 5-10 days.
|
Fig. 1. Ulcerative traumatic
granuloma on the anterior ventral part of the tongue; note
sloughing necrotic pseudomembrane, and dry lips. |
Riga-Fede disease, a variation of the traumatic
granuloma, may occur after acute injuries with sharp foodstuffs, biting,
or mastication. This unique type of chronic granulomatous ulceration
with stromal eosinophilia is a deep, pseudoinvasive, inflammatory
reaction seen in infants following chronic trauma from neonatal or
primary teeth. Differential diagnosis may include pyogenic granuloma,
ulcerative carcinoma, and lymphoma. Biopsy provides definitive
diagnosis. Removing the source of trauma is sufficient. Failure to
diagnose and treat RFD results in dehydration and inadequate intake for
the infant.
Taghi Azizi,
Mohammad Hosein Kalantar Motamedi,
Departments of Pathology and
Trauma Research,
Baqiyatallah University of Medical Sciences,
Tehran, Iran..