# Cheilitis Granulomatosa: A Case Report of a Sarcoid Mimic

## TL;DR

This case report describes a 46-year-old man with lip swelling diagnosed as cheilitis granulomatosa, highlighting possible infectious causes and treatment with mycophenolate.

## Contribution

The case provides evidence for infectious causes of cheilitis granulomatosa and highlights the need for further investigation.

## Key findings

- The patient showed significant improvement with mycophenolate treatment.
- Biopsy confirmed noncaseating granulomas, supporting a CG diagnosis.
- Saccharomyces and Lyme disease were notable in laboratory findings.

## Abstract

Cheilitis granulomatosa (CG) is a persistent and progressive swelling of the lips that can be non-tender and soft or firm to touch, with noncaseating granulomas that are perilymphatic and may show intralymphatic histiocytosis and lymphatic dilatation. CG can occur as an isolated condition or as part of Melkersson-Rosenthal syndrome, which also includes facial paralysis and a fissured tongue. The etiology of CG is currently unknown but has been hypothesized to be connected to genetics, allergies, immunological processes, and infectious causes. This case provides further evidence for the pathogenic causes of CG. We present a 46-year-old male patient with four years of progressive lip swelling to an outpatient rheumatological clinic, the cause of which has yet to be determined following numerous visits to healthcare providers. Corticosteroids were previously attempted, resulting in minor improvements in swelling; however, following discontinuation, the lip swelling returned. Laboratory findings were significant for Saccharomyces and Lyme disease, while other autoimmune biomarkers remained negative, and a biopsy indicated noncaseating granulomas, leading to the diagnosis of CG. The patient was started on mycophenolate, and following treatment, there was a significant reduction in the swelling of the lips. As the strongest cause of CG is currently unknown, this unique case brings awareness to the infectious causes leading to CG. It calls for a greater need to investigate the reason behind certain pathogens specifically targeting the lips without causing any other systemic effects.