Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE): a clinical case report

Abstract

Abstract. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, benign, and self-limiting oral lesion characterized by chronic ulceration and a distinctive eosinophil-rich inflammatory infiltrate. This case report presents a 45-year-old male patient with a chief complaint of a growing and mildly painful wound on the center of his tongue, which had been present for five weeks. History did not reveal any specific intraoral injuries, but the patient’s work is related to skydiving. Clinical examination revealed an oval lesion with dense edges on the dorsal part of the tongue, covered with a fibrinous coating, measuring about 1.5 cm in diameter, slightly painful on palpation. A decision was made to carry out an excisional biopsy, which was performed under local anesthesia, and sent for histopathological investigation. The morphological finding corresponded to the diagnosis, and the healing process went smoothly. TUGSE occurs worldwide across a broad age range, with peaks in infancy and middle age, and a slight male predominance. Its etiology is often linked to localized trauma, though other factors like viral infections and toxic agents may contribute. Histopathologically, it is characterized by eosinophil-rich granulation tissue with deep inflammatory infiltration, sometimes mimicking malignancies. Clinically, it presents as a slow-progressing ulcer, often mistaken for squamous cell carcinoma, with the tongue being the most common site. Treatment focuses on trauma removal, conservative management, and in persistent cases, surgical intervention, with a generally favorable prognosis. Overall, TUGSE poses diagnostic challenges, emphasizing the need for accurate clinical and histological diagnosis to ensure appropriate management.