Eosinophilic ulcer of the oral mucosa is a benign lesion of unclear pathogenesis mostly affecting the tongue. It has been suggested to represent a reactive pattern to several stimuli. We report on a 12-year-old boy who presented with a painless infiltrating ulcer on the gingiva of the lower jaw, which was covered by necrotic yellowish slough. There were no pathologic features of the jawbones or regional lymph nodes. Histopathological, immunohistochemical and gene rearrangement studies were in agreement with eosinophilic ulcer with predominant oligoclonal CD3+ and CD30+ T lymphocytes expressing the Epstein-Barr virus membrane protein. The ulcer resolved within 4 weeks and follow-up for 3 years revealed no evidence of recurrence. Epstein-Barr virus may have played a role in triggering this reactive lymphoproliferative disorder.

Hjorting-Hansen E, Schmidt H: Ulcerated granuloma e osinophilicum diutinum of the tongue: report of a case. Acta Derm Venereol 1961;41:235–239.
Sklavounou A, Laskaris G: Eosinophilic ulcer of the oral mucosa. Oral Surg Oral Med Oral Pathol 1984;58:431–436.
Doyle JL, Geary W, Baden E: Eosinophilic ulcer. J Oral Maxillofac Surg 1989;47:349–352.
Lombardi T, Kuffer R, Samson J: Eosinophilic ulceration of the oral mucosa: a case report. Int J Oral Maxillofac Surg 1993;22:366–367.
EI-Mofty SK, Swanson PE, Wick MR, et al: Eosinophilic ulcer of the oral mucosa: report of 38 new cases with immunohistochemical observations. Oral Surg Oral Med Oral Pathol 1993;75:716–722.
Mezei MM, Tron VA, Stewart WD, Rivers JK: Eosinophilic ulcer of the oral mucosa. J Am Acad Dermatol Nov 1995;33:734–740.
Bhaskar SN, Lilly GE: Traumatic granuloma of the tongue (human and experimental). Oral Surg Oral Med Oral Pathol 1964;18:206–218.
Regezi JA, Zarbo R J, Daniels TE, Greenspan JS: Oral traumatic granuloma: characterization of the cellular infiltrate. Oral Surg Oral Med Oral Pathol 1993;75:723–727.
Welborn JF: Eosinophilic granuloma of the tongue: report of a case. J Oral Surg 1966;24:176–179.
Wood GD, Hughes RO: Eosinophilic granuloma of the tongue. Dent Update 1986;13:378–379.
Tornes K, Bang G: Traumatic eosinophilic granuloma of the gingiva. Oral Surg 1974;38:99–102.
Ficarra G, Prignano F, Romagnoli P: Traumatic eosinophilic granuloma of the oral mucosa: a D30+ [Ki-1] lymphoproliferative disorder? Oral Oncol 1997;33:375–379.
Tang TT, Glicklich M, Hodach AE, et al: Ulcerative eosinophilic granuloma of the tongue: a light and electron microscopy study. Am J Clin Pathol 1981;75:420–425.
Movassaghi K, Goldman ML, Keith D: Ulcerative eosinophilic granuloma: a report of five new cases. Br J Oral Maxillofac Surg1996;34:115–117.
Elzay RP: Traumatic ulcerative granuloma with stromal eosinophilia: Riga-Fede’s disease and traumatic eosinophilic granuloma. Oral Surg Oral Med Oral Pathol 1983;55:497–506.
Elovic AE, Gallagher GT, Kabani S, Galli SJ, Weller PF, Wong DT: Lack of TGF-alpha and TGF-beta 1 synthesis by human eosinophils in chronic oral ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:672–681.
Rongioletti F, Nunzi E: Traumatic eosinophilic ulcer of the oral mucosa. Cutis 1989;43:357–359.
Labandeira J, Peteiro C, Toribio J: Traumatic eosinophilic ulcer of the oral mucosa: a misdiagnosed entity. Cutis 1996;57:349–351.
Eichenfield LF, Honig PJ, Nelson L: Traumatic granuloma of the tongue: Riga[-]Fede disease: association with familial dysautonomia. J Pediatr 1990;116:742–744.
McDaniel RK, Marano PD: Reparative lesion of the tongue. Oral Surg Oral Med Oral Pathol 1978;45:266–272.
Friedman KE, Venon SE: A recurrent ulcerating lymphohistiocytic lesion of the oral cavity. J Oral Maxillofac Surg 1983;41:325–328.
Eversole LR, Leider AS, Jacobsen PL, Kidd PM: Atypical histiocytic granuloma: light microscopic, ultrastructural, and histochemical findings in an unusual pseudomalignant reactive lesion of the oral cavity. Cancer 1985;55:1722–1729.
Ankjaergaard O, Lawaetz KD, Andreassen UK: Atypical histiocytic granuloma with eosinophilia. J Laryngol Otol 1988;102:543–545.
Morrison JW, Langston JR, Slater LJ: Atypical histiocytic granuloma: report of a case. J Oral Maxillofac Surg 1990;48:630–633.
25 de Vicente Rodriguez JC, Santos Oller JM, Junquera Gutierrez LM, López Arranz JS: Atypical histiocytic granuloma of the tongue: case report. Br J Oral Maxillofac Surg 1991;29:350–352.
Ruckley RW, Gordon D, Conroy B: Pseudolymphoma of the tongue mimicking Hodgkin’s disease: a case report. J Laryngol Otol 1984;98:737–741.
Kabani S, Cataldo E, Folkerth R, Delellis RA, Bhan I, Farren P, Neville T: Atypical lymphohistiocytic infiltrate (pseudolymphoma) of the oral cavity. Oral Surg Oral Med Oral Pathol 1988;66:587–592.
del Río E, Sánchez Yus E, Requena L, García Puente L, Vázquez Veiga H: Oral pseudolymphoma: a report of two cases. J Cutan Pathol 1997;24:51–55.
Segura S, Pujol RM: Eosinophilic ulcer of the oral mucosa: a distinct entity or a non-specific reactive pattern? Oral Dis 2008;14:287–295.
Chawla O, Burke GA, MacBean AD: The eosinophilic ulcer revisited. Dent Update 2007;34:56–57.
von Domarus H, Hoppe W, Willer M: Experimental study on the ‘traumatogenic’ eosinophilic granuloma of the tongue. Dtsch Zahnarztl Z 1980;35:90–92.
Axelrod FB, Cash R, Pearson J: Congenital autonomic dysfunction with universal pain loss. J Pediatr 1983;193:60–64.
Pilolli GP, Lucchese A, Scivetti M, Maiorano E, Favia G: Traumatic ulcerative granuloma with stromal eosinophilia of the oral mucosa: histological and immunohistochemical analysis of three cases. Minerva Stomatol 2007;56:73–79.
Hirshberg A, Amariglio N, Akrish S, Yahalom R, Rosenbaum H, Okon E, Kaplan I: Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Am J Clin Pathol 2006;126:522–529.
van der Waal I: Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009;45:317–323.
Eckardt A, Schultze A: Maxillofacial manifestations of Langerhans cell histiocytosis: a clinical and therapeutic analysis of 10 patients. Oral Oncol 2003;39:349–352.
Kemp S, Gallagher G, Kabani S, Noonan V, Ohara C: Oral non-Hodgkin’s lymphoma: review of the literature and World Health Organization classification with reference to 40 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:194–201.
Kasamatsu A, Kanazawa H, Watanabe T, Matsuzaki O: Oral sarcoidosis: report of a case and review of literature. J Oral Maxillofac Surg 2007;65:1256–1259.
Willemze R, Jaffe ES, Burg G, et al: WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105:3768–3785.
Moreno-Ramírez D, García-Escudero A, Ríos-Martín JJ, Herrera-Saval A, Camacho F: Cutaneous pseudolymphoma in association with molluscum contagiosum in an elderly patient. J Cutan Pathol 2003;30:473–475.
Gallardo F, Barranco C, Toll A, Pujol RM: CD30 antigen expression in cutaneous inflammatory infiltrates of scabies: a dynamic immunophenotypic pattern that should be distinguished from lymphomatoid papulosis. J Cutan Pathol 2002;29:368–373.
Cepeda LT, Pieretti M, Chapman SF, Horenstein MG: CD30-positive atypical lymphoid cells in common non-neoplastic cutaneous infiltrates rich in neutrophils and eosinophils. Am J Surg Pathol 2003;27:912–918.
Wong DT, Donoff RB, Yang J, et al: Sequential expression of transforming growth factors alpha and beta 1 by eosinophils during cutaneous wound healing in the hamster. Am J Pathol 1993;143:130–142.
Alobeid B, Pan LX, Milligan L, et al: Eosinophil-rich CD30+ lymphoproliferative disorder of the oral mucosa. Am J Clin Pathol 2004;121:43–50.
Liu HL, Hoppe RT, Kohler S, et al: CD30+ cutaneous lymphoproliferative disorders: the Stanford experience in lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. J Am Acad Dermatol 2003;49:1049–1058.
Pietersma F, Piriou E, van Baarle D: Immune surveillance of EBV-infected B cells and the development of non-Hodgkin lymphomas in immunocompromised patients. Leuk Lymphoma 2008;49:1028–1041.
Piletta PA, Wirth S, Hommel L, et al: Circulating skinhoming T cells in atopic dermatitis: selective up-regulation of HLA-DR, interleukin-2R, and CD30 and decrease after combined UV-A and UV-B phototherapy. Arch Dermatol 1996;132:1171–1176.
Guitart J, Hurt MA: Pleomorphic T-cell infiltrate associated with molluscum contagiosum. Am J Dermatopathol 1999;21:178–180.
Halvorsen JA, Brevig T, Aas T, Skar AG, Slevolden EM, Moi H: Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature. Acta Derm Venereol 2006;86:439–442.
Barnes CJ, Alió AB, Cunningham BB, Friedlander SF: Epstein-Barr virus-associated genital ulcers: an under-recognized disorder. Pediatr Dermatol 2007;24:130–134.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.