Eosinophilic ulcer of the mandibular gingiva with osteonecrosis: A case report

An eosinophilic ulcer of the oral mucosa is a benign and self-limiting lesion that usually occurs on the tongue and rarely affects the gingiva. We report a case of an eosinophilic ulcer of the mandibular gingiva associated with osteonecrosis. A 43-year-old woman with swelling and pain in the left mandibular molar region was referred to our hospital. She had burned her left mandibular gingiva while eating a hot apple pie 4 days ago. Physical examination revealed diffuse swelling in the left perimandibular region, and intraoral examination revealed mucosal necrosis in the left mandibular molar region. Eosinophilic granulomatosis with polyangiitis was suspected based on the histopathological findings. However, systemic examination revealed no other abnormality, and the patient was finally diagnosed with eosinophilic ulcer. Although the swelling and pain resolved following antibiotic administration and local irrigation, we observed bone exposure in the left mandibular second premolar region 12 days after the patient's initial visit. Sequestrectomy and tooth extraction were performed under general anesthesia. The patient had no recurrence at 15 months postoperatively. This case demonstrates that an eosinophilic ulcer can occur in the gingiva and alveolar mucosa and cause osteonecrosis. The features of eosinophilic ulcer resemble those of malignant tumors, and careful differential diagnosis is necessary.