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Background <p>Religious oral piercing practices, although culturally significant in certain regions, have been associated with rare but clinically important foreign body granulomatous reactions. These lesions often exhibit sarcoidal morphology, posing diagnostic challenges mimicking systemic granulomatous diseases such as sarcoidosis, tuberculosis, and deep fungal infections. We aimed to review the existing clinicopathological details of sarcoidal granulomatous reactions following ritual oral piercings.&#xa0;</p> Methodology <p>An electronic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to August 2025, supplemented by manual reference screening. Eligible studies included case reports and letters to the editor describing granulomatous reactions secondary to ritual oral piercing practices. Data on demographic profile, site, instrument used, clinical presentation, histopathological features, and management were extracted and analysed descriptively.</p> Results <p>Four manuscripts fulfilled the inclusion criteria, comprising three case reports and one letter to the editor, yielding a total of five patients. The cases originated from India and Malaysia, where ritual piercing is customary. Lesions predominantly affected the buccal mucosa, with one involving the tongue. Clinical presentation typically included firm nodules developing months to years after piercing. Histopathology consistently revealed non-caseating epithelioid granulomas with foreign-body type multinucleated giant cells. Special stains were negative for tuberculosis and deep fungal infections.</p> Conclusion <p>Sarcoidal foreign-body granulomatous reactions associated with ritual oral piercing represent a rare but important diagnostic entity that may mimic systemic granulomatous disease.</p>

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Sarcoidal Granulomatous Reaction to Religious Oral Piercing Practices: A Structured Clinicopathological Review

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Vasanthi V,
  • Rajkumar Krishnan,
  • Ramya Ramadoss,
  • J. Shanti Swarup

摘要

Background

Religious oral piercing practices, although culturally significant in certain regions, have been associated with rare but clinically important foreign body granulomatous reactions. These lesions often exhibit sarcoidal morphology, posing diagnostic challenges mimicking systemic granulomatous diseases such as sarcoidosis, tuberculosis, and deep fungal infections. We aimed to review the existing clinicopathological details of sarcoidal granulomatous reactions following ritual oral piercings. 

Methodology

An electronic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to August 2025, supplemented by manual reference screening. Eligible studies included case reports and letters to the editor describing granulomatous reactions secondary to ritual oral piercing practices. Data on demographic profile, site, instrument used, clinical presentation, histopathological features, and management were extracted and analysed descriptively.

Results

Four manuscripts fulfilled the inclusion criteria, comprising three case reports and one letter to the editor, yielding a total of five patients. The cases originated from India and Malaysia, where ritual piercing is customary. Lesions predominantly affected the buccal mucosa, with one involving the tongue. Clinical presentation typically included firm nodules developing months to years after piercing. Histopathology consistently revealed non-caseating epithelioid granulomas with foreign-body type multinucleated giant cells. Special stains were negative for tuberculosis and deep fungal infections.

Conclusion

Sarcoidal foreign-body granulomatous reactions associated with ritual oral piercing represent a rare but important diagnostic entity that may mimic systemic granulomatous disease.