3. Persistent lip swelling

A 12-year-old schoolgirl complained of swollen lips. The complaint was first noticed just after orthodontic treatment in 2007–2008, about one month after she started wearing her wire retainer (July 2008). She began with painless persistent swelling, first of the right upper lip, spreading to the left upper and then also to the lower lip. This persisted, despite her replacing the wire retention with plastic retention, though she still had wire in the lower. She had patch tests for metals which were positive for mercury, chromium and iridium.

She had always suffered from recurrent oral ulcers, as had her mother and brother. She had had no oral lumps or gingival lesions. There were no cutaneous, gastro-intestinal, genital, ocular or joint problems and no history of fever. She had no weight loss. In 2007–2008, she was on antibiotics for latent TB as she was in a class taught by a person with open TB. In 2008, she had an ear piercing slightly complicated by inflammation.