Oral Medicine Case Book 57: Orofacial granulomatosis

A 17-year old female presented at the Oral Medicine Clinic with the complaint of persistent swelling of the upper lip and anterior attached gingiva, causing her discomfort when eating and talking. The swelling started approximately ten months earlier. At the time she was seen by her physician who prescribed an antibiotic that gave mild symptomatic relief, but no clinical resolution. She was also seen by an oral hygienist on three occasions with no improvement of the gingival swelling. The patient also reported that she had been diagnosed with depression and type 2 diabetes approximately two years ago and was currently using Citalopram (a selective serotonin reuptake inhibitor) and Glucophage (metformin hydrochloride, an anti-hyperglycemic drug). Extra-oral examination revealed a firm, swollen and superficially cracked upper lip with a red granular appearance. No enlarged cervical lymph nodes could be palpated. Intra-orally, the anterior maxillary and mandibular gingivae were hyperplastic and erythematous, with a granular surface (Figures 1, 2 and 3). The differential diagnosis included contact allergy and granulomatous disease, including mycobacterial infection.DHE