NOT ALL LIP SWELLING IS ANGIOEDEMA

Abstract

Introduction Cheilitis granulomatosa (CG) is a rare form of recurrent or persistent swelling of one or both lips and one form of orofacial granulomatosis. It is important for allergists to consider the need for mucosal biopsy in patients initially referred for angioedema, especially if the lip swelling has been persistent. Case Description A 35-year-old female presented with 2 months of constant lip swelling. Swelling was worse in the morning with some improvement in the evening although was always present. Early in the course, she was treated with prednisone for one week and antihistamines with initial improvement, but the swelling recurred. Lip swelling was not associated with any tongue swelling, hives, difficulty breathing, or facial paralysis. She had no previous history of angioedema, allergic rhinitis, or asthma. On physical exam, right lower lip was enlarged without any oropharyngeal or tongue swelling. There was mild desquamation of the lips. Patient was initially treated with topical steroids given suspicion for contact dermatitis related to frequent lip balm use. Given persistent symptoms, a lip biopsy was recommended, which was consistent with CG. The patient is now receiving intralesional triamcinolone with improvement of the swelling. Discussion The differential diagnosis for lip swelling is vast. CG along with other granulomatous diseases should be considered when the swelling is persistent with or without associated surface epithelial changes, both of which should not be seen in angioedema of any cause. It is important not to miss this diagnosis due to its association with Crohn's disease.