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.
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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.
