Two typical and one atypical presentation of TUGSE: Case series and literature review.

Background: Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, reactive oral mucosal lesion characterized by dense eosinophilic infiltration. Although often linked to trauma, immune-mediated mechanisms may also contribute. Clinically, TUGSE can mimic malignancy or infection.

Case presentation: We report three cases of TUGSE with variable presentations. The first two cases involved classic ulcerative lesions on the lateral tongue, both of which healed spontaneously following biopsy. The third case presented as a deep cold abscess extending from the lingual cortex to the mandibular base following third molar extraction-an uncommon presentation. All lesions were histopathologically diagnosed as TUGSE.

Conclusion: These cases demonstrate the clinical spectrum of TUGSE and highlight the importance of early biopsy and histopathological evaluation in persistent oral ulcers to ensure diagnostic accuracy and guide appropriate management. Recognizing atypical presentations may help avoid misdiagnosis and unnecessary interventions.