Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Abstract

Macrocheilia, as an initial manifestation of leprosy, is uncommon. We present a case of a 50‐year‐old female, with lower lip swelling, initially diagnosed as Cheilitis Granulomatosa Miescher. Unresponsiveness to local intralesional corticosteroids necessitated further evaluation. Repeat tissue sampling yielded a confirmatory diagnosis of borderline tuberculoid leprosy, which was managed successfully.

Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case

“…Furthermore, CGM is distinguished by perivascular mononuclear infiltration, lymphedema, and fibrosis. On the contrary, leprosy is distinguished by upper dermis granulomas and perineural and periadenexal infiltrates consisting of foamy cells, plasma cells, and lymphocytes [24,32]. In the case presented, MRS may be ruled out by the absence of facial paralysis and a fissured tongue.…”

“…A detailed literature search carried out on the Google Scholar and PubMed search engines revealed only seven case reports [17,[20][21][22][23][24][25], and two retrospective studies [19,26] of chronic macrocheilia as the manifestation of leprosy (…”

“…Facial paralysis can manifest in both MRS and leprosy, as trigeminal nerve paralysis has been documented in leprosy cases. However, the presence of a distinctively fissured tongue is a diagnostic hallmark of MRS [21,24].…”

“…In leprosy, the accompanying skin lesions exhibit warmth, tenderness, and scaliness. Moreover, the lesion's margin extends beyond the lip, providing subtle distinctions that differentiate it from CGM [24,26]. Microscopically, both leprosy and CGM exhibit non-caseating granulomas with multinucleated Langhans-type giant cells.…”