Orofacial granulomatosis as a presenting feature of Crohn's disease. BMJ Case Rep. 2015 Jan 9. 2015:[QxMD MEDLINE Link]. El-Hakim M, Chauvin P. Orofacial granulomatosis presenting as persistent lip swelling: review of 6 new cases. [emedicine.medscape.com]

The gross appearance of the upper lip upon presentation. [ncbi.nlm.nih.gov]

The article reports the case of a 13-year-old boy who presented with epigastralgia and fever for ten days. [medicoebambino.com]

• Myopathy

  Melkersson-Rosenthal syndrome: distal facial nerve branch palsies, masseter myopathy and corticosteroid treatment. Fukushima J Med Sci. 1994 Jun. 40(1):39-44. [QxMD MEDLINE Link]. [emedicine.medscape.com]

Therefore, such testing should be included in the workup of patients with suspected OFG. In the case of our patient, a 2-months trial of dapsone 100 mg p.o. b.i.d. was given. [ncbi.nlm.nih.gov]

• Borrelia Burgdorferi

  Borrelia burgdorferi (a spirochete responsible for Lyme’s disease) has been suggested in a pathogenic role, but polymerase chain reaction (PCR) has not been able to identify any Borrelia-specific DNA CG patients [3]. [ncbi.nlm.nih.gov]

  burgdorferi but provide insufficient evidence Immunological - Hypothesis that no single antigen causes disease, rather a random influx of inflammatory cells; delayed sensitivity reaction rather than super antigen; results reflect an immunological nature [emedicine.medscape.com]

Treatment of recalcitrant cheilitis granulomatosa with metronidazole. J Am Acad Dermatol. 1992 Oct. 27(4):629-30. [QxMD MEDLINE Link]. Coskun B, Saral Y, Cicek D, Akpolat N. [emedicine.medscape.com]

Treatment There is no definitive treatment for cheilitis granulomatosa, and this is complicated by the poorly understood mechanism of disease. [ncbi.nlm.nih.gov]

Esophagusgastroduodenoscopy and ileocolonscopy showed macroscopic and histological findings that were compatible with Crohn’s disease. 8 weeks of exclusive oral polymeric diet treatment, in association with azathioprine after 2 weeks from the beginning [medicoebambino.com]

[…] burgdorferi but provide insufficient evidence Immunological - Hypothesis that no single antigen causes disease, rather a random influx of inflammatory cells; delayed sensitivity reaction rather than super antigen; results reflect an immunological nature Prognosis [emedicine.medscape.com]

Approach to Lip Swelling Lip swelling can be a perplexing presentation, and common etiologies must first be ruled out before more invasive and expensive testing is done. [ncbi.nlm.nih.gov]

However, cases may present as early as age 3 years and as late as age 78 years. [10] Etiology The cause of granulomatous cheilitis is unknown. [11] Normal lip architecture is altered by lymphedema and noncaseating granulomas in the lamina propria. [emedicine.medscape.com]

Epidemiology While the actual frequency is unknown, one study estimated its incidence at 0.08% of the general population. [9] Onset of granulomatous cheilitis is usually in young adult life. [emedicine.medscape.com]

Corticosteroids are widely used for CG and have been shown to be effective in reducing facial swelling and preventing recurrence [1] but have side effects when used long-term. [ncbi.nlm.nih.gov]

Recurrent facial palsy in Melkersson Rosenthal syndrome: total facial nerve decompression is effective to prevent further recurrence. Am J Otolaryngol. 2015 May-Jun. 36 (3):334-7. [QxMD MEDLINE Link]. Saalman R, Mattsson U, Jontell M. [emedicine.medscape.com]