Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) in children: a case report and literature review

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, self-limiting, chronic benign lesion of the oral mucosa, whose pathophysiology remains unclear. This article reports an 8-year-old male child who presented with recurrent oral ulcers for more than 2 years, with non-fixed ulcer locations. In the past year, the frequency of ulcer occurrences increased, and healing was delayed. In the past month, the pain intensified, affecting his eating. Oral examination revealed a 30 mm × 15 mm deep ulcer in the left lower posterior teeth area, covered with a yellow-white pseudomembrane and without surrounding hyperemia. Histopathology showed dense eosinophil infiltration and skeletal muscle inflammation. Immunohistochemistry demonstrated positivity for CD30, CD34 and other markers, confirming the diagnosis of TUGSE Treatment included correcting poor oral habits, topical application of growth factor gel, and symptomatic medication. Follow-up showed improvement in ulcer recurrence frequency and size, but complete control was not achieved. TUGSE in children manifests as refractory recurrences, requiring histopathological diagnosis to exclude malignancies and other diseases. Local treatment can alleviate symptoms, but long-term recurrences suggest the need for further exploration of underlying etiologies and personalized interventions.