Eosinophilic Ulcer of the Tongue in Smokeless Tobacco "Shamma User”: Case Series Report

Abstract

Oral eosinophilic ulcers (OEU) are rare, benign, reactive, and often self-limiting lesions. As the lesion is self-limiting, it develops rapidly,usually disappearing after several weeks. Although the exact pathogenetic mechanisms are unknown, the possibility that trauma may play a rolehas been postulated. The lesion frequently misleads to the suspicion of squamous cell carcinoma because of its prolonged duration. Despite traumabeing suggested as the main culprit of oral eosinophil ulcers, the exact pathogenesis mechanism of this disease remains controversial. However, itmay misdiagnose as malignancy, particularly in smokeless tobacco "Shamma users." The study emphasizes the clinical and histopathological aspectsof diagnosing and treating this pathology. The study aims to demonstrate the importance of knowledge and its course. The novelty of our studycan be described in terms of thorough early clinical diagnosis with confirmatory histopathological findings that can aid towards perfect diagnosis,as part of treatment - removal of etiological factors (trauma) saw the Oral eosinophilic ulcers (OEU) completely healed, which was earlier can bemisdiagnosed as malignancy based on the use of Shamma smokeless tobacco by patients for a longer period. We present the two male cases ofSaudi residents with a long history of painful ulcers on the lateral borders of the tongue. Both had a long history of being "Shamma users" ofsmokeless tobacco. The ulcers were ulceration with indurated and elevated borders and no evidence of regional lymph node involvement.Histopathologically, the lesion showed an infiltrate with several eosinophils, was ulcerated, and no cellular atypia was observed. After the treatment,the ulcer rapidly healed with an incisional biopsy and the cause removal. A definite diagnosis was achieved by combining histologic findings andclinical follow-up. A biopsy is not only the best approach for a proper diagnosis but also for its therapeutic management. Understanding thisdisease is necessary since its lesion can mimic an oral squamous cell carcinoma occurring as an indurated ulceration coupled with its frequentoccurrence on the tongue.