Effectiveness of surgical treatment of severe macrocheilia in a patient with orofacial granulomatosis

Cheilitis Granulomatosa: A Case Report of a Sarcoid Mimic

Cheilitis granulomatosa (CG) is a persistent and progressive swelling of the lips that can be non-tender and soft or firm to touch, with noncaseating granulomas that are perilymphatic and may show intralymphatic histiocytosis and lymphatic dilatation. CG can occur as an isolated condition or as part of Melkersson-Rosenthal syndrome, which also includes facial paralysis and a fissured tongue. The etiology of CG is currently unknown but has been hypothesized to be connected to genetics, allergies, immunological processes, and infectious causes. This case provides further evidence for the pathogenic causes of CG. We present a 46-year-old male patient with four years of progressive lip swelling to an outpatient rheumatological clinic, the cause of which has yet to be determined following numerous visits to healthcare providers. Corticosteroids were previously attempted, resulting in minor improvements in swelling; however, following discontinuation, the lip swelling returned. Laboratory findings were significant for Saccharomyces and Lyme disease, while other autoimmune biomarkers remained negative, and a biopsy indicated noncaseating granulomas, leading to the diagnosis of CG. The patient was started on mycophenolate, and following treatment, there was a significant reduction in the swelling of the lips. As the strongest cause of CG is currently unknown, this unique case brings awareness to the infectious causes leading to CG. It calls for a greater need to investigate the reason behind certain pathogens specifically targeting the lips without causing any other systemic effects.

[New diagnostic classification of cheilitis and its clinical diagnostic pathway]

Cheilitis is a general term for various types of inflammatory diseases that occur on the lips. The etiology differs and the clinical manifestations and pathological features overlap, leading to difficulties in clinical diagnosis. Reasonable classification is conducive to the diagnosis of cheilitis. However, its classification is difficult because of its cha-racteristics. At present, scholars have proposed two different classification schemes, but a unified classification standard has not yet been established. We classified cheilitis based on its etiology, clinical manifestations, pathological characteristics, and relationship with systemic and special diseases on the basis of special medical reports and by combining clinical practice experience and summarizing previous cheilitis diagnosis and treatment literature. In accordance with this classification method, we proposed suggestions for the clinical diagnosis of cheilitis to provide a reference for the clinical diagnosis and treatment of complex cheilitis.

A case of Melkersson-Rosenthal syndrome with endocrine disorders: Extraordinary efficiency of hydroxychloroquine and mechanism hypothesis

BACKGROUND AND PURPOSE

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disease. In addition to the traditional clinical triad, there is also a diversity of clinical signs, and it may be related to other systemic diseases.

METHODS

In the present study, we report a case of MRS with endocrine disorders that exhibits extraordinary therapeutic efficiency by using hydroxychloroquine (HCQ), explore whether there is an internal connection between MRS and endocrine disorders, and discuss the mechanism of the therapeutic efficiency of using HCQ. The hypothesis proposed for the first time is that MRS may essentially be a systemic granulomatous disease.

RESULTS

The physical examination revealed orofacial swelling and fissured tongue. The histopathologic examination showed epithelioid granulomas. Combined with the other examination, this case was diagnosed as incomplete MRS. HCQ and local drugs were introduced. The patient achieved clinical recovery and psychological cure by the 18-week follow-up, and the 1-year follow-up found no reactivation of MRS. Moreover, the levels of cortisol and adrenocorticotropic were within normal ranges.

CONCLUSIONS

After the drug therapy was targeted at granuloma, not only did all of the symptoms related to MRS disappear, but the endocrine system also returned to normal. It is speculated that the endocrine disorder in this patient may be related to MRS. We further propose the first-time hypothesis that MRS may essentially be a systemic granulomatous disease. It provides a new medication method with high-level efficiency.