SIGNS, SYNDROMES AND DIAGNOSES Eosinophilic ulcer of the tongue

A 76-year-old woman presented with a 1-month history of a rapidly expanding ulcerated nodule on the right lateral border of her tongue. The patient had severe pain that disturbed her eating. A tooth had been extracted under local anaesthesia 2 days prior to the onset of the ulcer. The patient stated that her tongue had been quite traumatized during the extraction. Topical antiseptic mouthwashes and oral analgesics had been given during the dental extraction. She denied any other physical or chemical injuries. The patient was taking no other medications. Her past medical history was unremarkable. She did not have a history of aphthous ulceration or stomatitis, vasculitis, autoimmune connective tissue diseases, or sensory or autonomic dysfunction. On dermatologic examination, a regularly shaped nodule 1 cm in diameter with central punched-out ulceration and rolled edges was observed (Fig. 1). The lesion was hard on palpation. She was in good general health otherwise, and no lymphadenopathy was noted. Results of a full blood count were normal. Results of VDRL and anti-HIV antibody were negative. The ulcerated nodule persisted despite a 1-month course of triamcinolone acetonide ointment (0.1% b.d.) application. We performed a total excision of the lesion for histopathologic examination with the differential diagnoses of eosinophilic ulcer of the tongue, squamous cell carcinoma and extranodal non-Hodgkin lymphoma. Histopathological examination showed an ulcerated surface and mixed inflammatory infiltrate consisting predominantly of eosinophils extending into the mucosa, submucosa and the layers of the striated muscle fibres. No cellular atypia was observed (Fig. 2). The diagnosis was eosinophilic ulcer of the tongue. At 1-year follow-up there was no recurrence.