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Indian Pediatr 2009;46: 907-908

Persistent Swelling of Lip


AM Vijayalakshmi and A Jayavardhana

PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore 641 004, TN, India.
Email: [email protected]
 
 


A 10-year-old boy presented with history of recurrent swelling of both lips for 6 months and persistent swelling since 20 days. There was no history of applied irritants, local trauma or atopy. On examination his lips were swollen, firm and non tender (Fig. 1). There was no urticarial rash, facial palsy or fissured tongue. The findings of systemic examination were normal. The findings of routine blood workup and X-ray chest were normal. Based on the clinical features a diagnosis of granulomatous cheilitis was made. Biopsy of lip showed multiple epitheloid cells in the dermis along with giant cells and perivascular infiltrate of lymphocytes, histiocytes and plasma cells suggestive of granulomatous cheilitis. The child was started on clofazimine and steroids.

Fig. 1 Swollen lips due to granulomatous cheilitis.

Granulomatous cheilitis is a chronic, painless swelling of lips due to granulomatous inflammation. Episodic enlargement of the lips ultimately persists. Miescher cheilitis is the term used when granulomatous changes are confined to lip. Melkerson-Rosenthal syndrome is the term used when cheilits occurs with facial palsy and fissured tongue. The cause of granulomatous cheilitis is unknown. The differential diagnosis of granulomatous cheilitis includes angioedema, crohn disease, sarcoidosis, actinic cheilitis, cheilitis glandularis, neoplasms and infections such as tuberculosis, syphilis and leprosy. Treatment of granulomatous cheilitis is difficult and rate of recurrence is high. Treatment options include corticosteroids, clofamine, metronidazole, sulfas-alazine, infliximab and cheiloplasty.
 

 

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