Black hairy tongue in a 2-month-old infant

Abstract:   Black hairy tongue (BHT) is an unusual condition in adults, and is characterised by marked accumulation of keratin on the filiform papillae of the dorsum of the tongue resulting in a hairlike appearance. The colour of the papillae may vary from brown to black. We describe a case of BHT in a 2-month-old infant. An extended review of the literature suggests that our case is the youngest ever reported. In conclusion, although BHT is considered benign, clinical, haematological and histological, evaluation is recommended to exclude several entities which can present as pigmented lesions of the oral mucosa.     

Deformity of the tongue in an infant: Riga-Fede disease

Riga-Fede is the rare condition of benign ulceration caused by repetitive trauma to the lingual tissues by the teeth in children younger than two years of age. The differential diagnosis includes infective and neoplastic conditions. Histological diagnosis is required when the symptoms fail to resolve with standard management. The case involving an 11-month-old girl who presented with ulceration of the tongue, resulting in a reasonable defect of the tongue tip, is reported in the present article. Following excisional biopsy, the lesion healed without subsequent recurrence. Riga-Fede disease should be considered in infants presenting with oral ulceration. Extraction of the offending teeth should be considered when associated with failure to thrive or failed conservative management.     

Enlargement of the tongue in sudden infant death syndrome.

Anatomic details of the infantile oropharynx and relationships to possible airway obstruction in sudden infant death syndrome (SIDS) are understood incompletely. Tonkin recognized this in 1975, suggesting that enlargement of the tongue might be important in SIDS, within the context of other anatomic and physiologic factors unique to early life. We therefore conducted a morphometric study of the tongue in 100 victims of SIDS and 36 control infants; the latter group consisted of infants with the same range in age and body size who had grown normally and died acutely. Highly significant differences in tongue weight, width, and thickness were demonstrated between the two groups by linear regression and analysis of covariance. Two multivariate techniques, stepwise discriminant analysis and factor analysis, identified marked discordance between somatic and lingual size in SIDS and a statistical uniqueness in tongue thickness. Certain explanations for lingual enlargement in SIDS were ruled out: redistribution of fluid and other effects of death, postmortem interval, duration and mode of feeding, and smallness of control tongues. At present, the functional significance of these observations is unclear. The effects of both normal and increased tongue size on airway patency are, however, widely recognized. Further studies of the enlarged tongue, addressing such topics as in situ anatomy and developmental mechanisms, are necessary to establish the potential for pathophysiologic consequences in SIDS.     

Lactobezoar in an infant

The authors report a new case of lactobezoar in a 45 day-old infant. Vomiting was the presenting sign. The diagnosis was made using radiologic examination of the gastro-intestinal tract. Medical treatment (digestive rest and parenteral rehydration) resulted in a favourable outcome. The factors favouring such a situation and its management are analysed.     

Acromegaly in an infant

Serial hormonal studies were carried out in a girl with a growth hormone-secreting pituitary adenoma and hyperprolactinemia diagnosed at 21 months of age, the youngest verified case of acromegaly. The child had progressive macrocephaly, noted at 6 months of age, which preceded the rapid acceleration of linear growth by nearly 1 year. At 21 months of age, the girl's head circumference measured 55 cm (+5.5 SD) and her height was 97.6 cm (+4.4 SD). Preoperative serum growth hormone level was 135 ng/mL, somatomedin C was 1,540 ng/mL (normal for bone age 18 to 97 ng/mL), and prolactin was 370 ng/mL (normal less than 20 ng/mL). Following total resection of a large adenoma, immunohistochemical staining of the tumor showed growth hormone but not prolactin. With longitudinal monitoring of the child for 2 years postoperatively, persistently low growth hormone levels were demonstrated and normal growth velocity (6 cm/yr). Peak serum growth hormone levels ranged from 2.8 to 4.1 ng/mL after stimulation tests with insulin, arginine, and L-dopa. Maximum sleep-entrained growth hormone level was 3.4 ng/mL. At the same time, serum somatomedin C levels measured serially were normal (29 to 111 ng/mL), whereas simultaneous prolactin levels were moderately increased (30 to 147 ng/mL). The data support the hypothesis that hyperprolactinemia may have contributed to stimulating somatomedin C and sustaining the normal growth rate in this child.     

婴儿球孢子菌病一例

患儿,男,5个月,因发热咳嗽1个月余,加重2 d于2004年9月22日入院.患儿于1个多月前无明显诱因出现发热,以夜间为主,体温不超过38℃,伴单声轻咳,无痰,无气促等不适.曾在当地医院予抗感染治疗效果不佳.入院前2 d病情加重,体温升高到39℃以上,最高达40.5℃,予退热药后,热可退,但易反复.咳嗽加重,为刺激性干咳伴气促.起病来,精神较差,吃奶、睡眠可,黄色稀便3～4次/d,小便正常,无抽搐,全身无皮疹,无呕吐.既往史无特殊.