Case Report Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy Ambika Gupta and Harneet Singh Department of Oral Medicine and Radiology, Pandit B.D. Sharma UHS (PGIDS), Rohtak, Haryana, India Correspondence should be addressed to Ambika Gupta; drambika79@redifmail.com Received 25 June 2014; Accepted 30 September 2014; Published 15 October 2014 Academic Editor: Bhushan Kumar Copyright © 2014 A. Gupta and H. Singh. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Granulomatous cheilitis is a rare, idiopathic, infammatory disorder which usually afects young adults. It is characterized by persistent, difuse, nontender, sof-to-frm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up. 1. Introduction Orofacial granulomatosis comprises a group of diseases characterized by noncaseating granulomatous infammation afecting the sof tissues of the oral and maxillofacial region [1]. Te term, introduced by Wiesenfeld et al. in 1985, includes Melkersson-Rosenthal syndrome and cheilitis gran- ulomatosa of Miescher [2]. Melkersson-Rosenthal syndrome manifest itself as a triad of recurrent or persistent lip or facial swelling, recurrent, partial, or complete facial paral- ysis, and fssured tongue [3, 4]. Cheilitis granulomatosa of Miescher is characterized by swelling restricted to the lips [5]. Granulomatous cheilitis is considered a monosymptomatic form of Melkersson-Rosenthal syndrome by some clinicians. Te etiology of this disease is unclear, but the condition has been linked to an abnormal immune reaction. Te available therapeutic options provide only limited and temporary remissions. Two cases of granulomatous cheilitis are being reported, who showed an excellent and sustained response to combination of intralesional steroids, metronidazole, and minocycline. 2. Case 1 A 17-year-old female reported in an outdoor department of Oral Medicine at Government Dental College, Rohtak, with a 2-year history of persistent asymptomatic swelling of the upper lip and occasional gingival swelling (Figure 1). Her medical history was noncontributory. Tere was no history suggestive of abdominal cramps, diarrhea, fatigue, weight loss, or any other gastrointestinal disorders. Systemic examination did not reveal any abnormalities. Examination revealed a nontender, difuse, frm swelling of the upper lip. Te surrounding facial skin showed difuse erythema- tous swelling. Te surface of the lip was smooth with no signs of scabs, bleeding, or exudation. No fssuring of the tongue, oral ulcers, or hypertrophy of the oral mucosa was noticed. Tere was no palsy of facial muscles. Te patient had received intralesional triamcinolone injections in the past with temporary remissions and recurrences of the swelling. A chest radiograph, complete haemogram, ery- throcyte sedimentation rate, serum folate, iron, and vitamin B12 levels, serum levels of angiotensin-converting enzyme, were ordered, which were in normal range. Te tuberculin skin test for tuberculosis was negative. Ultrasonography of the upper lip revealed a mildly increased vascularity in the region. Te diagnosis of cheilitis granulomatosa was con- frmed on a histopathological examination, which revealed Langhans type giant cells, epithelioid cells, lymphocytes, and few neutrophils (Figure 2). We decided to treat her with a combination of intralesional weekly injections of triamci- nolone acetonide 10 mg/mL in the upper lip for 4 weeks, along with oral metronidazole 400 mg three times a day Hindawi Publishing Corporation Case Reports in Dermatological Medicine Volume 2014, Article ID 509262, 4 pages http://dx.doi.org/10.1155/2014/509262