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Lips do not lie
  1. Rachel Haigh1,
  2. Lauren Grahame1,
  3. Pramodh Vallabhaneni2
  1. 1 Swansea University College of Medicine, Swansea, UK
  2. 2 Child Health, Swansea Bay University Health Board, Port Talbot, UK
  1. Correspondence to Dr Pramodh Vallabhaneni, Child Health, Swansea Bay University Health Board, Port Talbot, UK; Pramodh.vallabhaneni{at}

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A 14-year-old boy presented with an 18-month history of lower lip swelling (figures 1 and 2). There was no history of associated trauma or pain. Occasional episodes of runny stools with no presence of mucous or blood were described. There was no other history of swelling or pain. There was no early morning worsening of his lower lip swelling or breathing difficulties. No skin rashes or pruritus was reported. He had suffered from mouth ulcers and perianal abscesses requiring surgical intervention when he was 5 years old. Systemic and perianal examination was normal. Urine dipstick revealed no protein/haematuria.

Figure 1

Lower lip swelling.

Figure 2

Lower lip swelling.

Test your knowledge

Question 1

What is the most probable cause of this facial appearance?

  1. Oro-facial granulomatosis (OFG)/Crohn’s disease(CD)

  2. Hereditary angioedema (HA)

  3. Mastocytosis

  4. Oral allergy syndrome

  5. Hypothyroidism

Question 2

What initial …

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  • Contributors RH and LG wrote the first draft. PV conceived the idea and revised the first and wrote the final draft. RH, LG and PV are all first authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.