Abstract
Case 1 : A 54-year-old man had developed a swelling of his lower lip from three months previously and had been treated with an oral antihistamine and a topical steroid by a local doctor. However, he visited us because the symptoms had not improved. At the first visit, a swelling was observed in the lower right lip. The histopathological findings indicated a noncaseating epithelioid granuloma consisting of lymphocytes, histiocytes, and giant cells. In the metal patch test, a positive response to zinc was observed. The removal of dental metal materials did not improve the symptoms, and oral roxithromycin, minocycline, and tranilast had no effect. However, oral prednisolone (PSL) greatly alleviated the symptoms and the swelling resolved, following which PSL was tapered off to zero. After that, the symptoms reoccurred once but the swelling of the lip disappeared immediately following treatment with oral PSL, and no recurrence has been experienced since then. Case 2 : A 20-year-old woman had developed a swelling of her lower lip from six months previously. She had received treatment with Celestamine® and a topical steroid by a local doctor, but she visited us because the symptoms had not improved. At the first visit, a swelling was observed in the lower right lip. The histopathological findings indicated a noncaseating epithelioid granuloma consisting of lymphocytes, histiocytes, and giant cells. In the metal patch test, a positive response to zinc was observed. The combination of tranilast and roxithromycin taken orally improved the symptoms significantly ten months later and the swelling of the lip resolved. No recurrence has been observed thereafter.
