Abstract:

A 50-year-old female presented for a 6-month history of a non-healing, painful lower lip ulcer. The ulcer was ~2cm with indurated borders. An infectious etiology was initially suspected, however, there was no improvement with a course of antivirals and antibiotics. A biopsy was then performed and demonstrated a dense mixed inflammatory infiltrate with numerous eosinophils, their degranulation products, and large atypical mononuclear cells, some of which stained for CD30. After negative AFB, GMS, PAS, spirochete and HSV1-2 stains, a diagnosis of eosinophilic ulcer of the oral mucosa (EUOM) was rendered. The lesion was successfully treated with intralesional corticosteroids. EUOM is a rare, benign, poorly understood condition that clinically mimics malignancy or infection. It most frequently develops around the fifth decade and presents as a rapidly growing, painful ulcer on the tongue (60%), buccal or labial mucosa. Characteristic features include an ulcer with yellow, fibrinous material and indurated borders. Histopathological features include a dense inflammatory infiltrate with eosinophils and degeneration of muscle fibers. Large, atypical, mononuclear cells, which more recently have been identified as CD30+ T cells, are present. Although the exact etiopathogenesis remains unclear, it is likely a self -limited, T-cell mediated process related to trauma, although a history of preceding trauma is reported in fewer than 50% of cases. The presence of CD30+ T cells raises the question of whether this a primary cutaneous CD30+ lymphoproliferative disorder. The majority of T-cell rearrangement studies fail to demonstrate clonality suggesting a reactive process. Treatment studies are scarce although successful treatment has been reported with corticosteroids, excisions, and trauma avoidance.

Financial Disclosure:
No current or relevant financial relationships exist.

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Kelly Mueller, MD