Annular Plaques on the Tongue: What Is Your Diagnosis?

Geographic tongue is an inflammatory disorder of the tongue characterized by asymptomatic erythematous patches with serpiginous borders. Candidiasis of the tongue may be confused with geographic tongue. A 63-year-old male patient with painful white annular lesions localized to the left side of his tongue is presented. He applied topical corticosteroid and antiinflammatory agents, but his lesions did not respond to those therapies. Using direct mycologic examination and culture, the patient was diagnosed with candidiasis. After systemic and topical antifungal therapy, clinical improvement was observed. With this case, the clinical forms of oral candidiasis were discussed, and it was suggested that the clinical presentation of mucosal candidiasis may vary according to the stage of infection and individual immunity.     

以肌病为首发表现的系统性淀粉样变性一例

目的 探讨系统性淀粉样变性的临床病理特点,鉴别诊断,治疗与预后.方法 分析我科收治的1例以肌肉表现为首发症状的系统性淀粉样变性的临床、病理、实验室检查特点,并对文献进行复习.结果 该患者以全身肌肉变硬、巨舌为首发症状,检查进一步发现心血管系统、呼吸系统、消化系统、肾脏受累.经皮肤、肌肉、胃肠黏膜组织病理H-E染色、刚果红染色、偏振光显微镜检查证实为系统性淀粉样变性.结论 系统性淀粉样变性可以肌肉病变为首发表现.     

Glossitis and other tongue disorders

Patients frequently present complaining of tongue abnormalities. Knowledge of normal tongue anaomy an d architecture enable the clinician t odifferentiate variations of normal from abnormal conditions. Many tongue conditions are benign and. require reassurance and explanation, with little to no treatment. Others can signify systemic disorders. Examination of the tongue is an integral part of a complete physical examination. Recognizing the disorders of the tongue that are benign and do not require treatment or further evaluation prevents unnecessary testing for the patient. Careful evaluation of the tongue may provide valuable clues to a systemic disorder.     

以消化道症状为主要表现的原发性系统性淀粉样变病1例

患者男,45岁。纳差8个月,反复腹泻1个月。患者以消化道症状为首发症状,进一步检查发现双上眼睑及四肢见片状紫癜,巨舌,并累及心脏、喉部、心包、胸膜、腹膜。结合直肠组织病理学表现黏膜下层伊红染无定形物沉积,甲基紫、刚果红染色阳性,尿κ、λ链异常。诊断:原发性系统性淀粉样变病。     

Recalcitrant oral pyoderma gangrenosum in a child responsive to cyclosporine

We report a case of recalcitrant pyoderma gangrenosum which developed on the tongue of an 8-year-old, previously healthy boy without any systemic associated disease. The lesion was confined to the tongue and was not responsive to conventional treatment with prednisolone and sulfa drug, but it showed dramatic improvement with oral cyclosporine therapy. In addition, the histopathology of the lesion included many eosinophils, which caused difficulties in diagnosis to differentiate this condition from other oral ulcerative diseases showing tissue eosinophilia including eosinophilic ulcer of the tongue.     

Congenital Melanotic Macules of the Tongue. A Case Report and Brief Review of the Literature

Congenital melanotic macules of the tongue (CMMT) are a rare and benign condition that is probably underestimated. We report the case of an African infant with multiple congenital hyperpigmented macules of the tongue. To avoid a difficult‐to‐perform procedure such as a tongue biopsy, focused clinical monitoring was performed every 3 months for 30 months to detect significant changes. A clinical diagnosis of CMMT was made in the absence of concomitant systemic diseases using the clinical findings, the location on the tongue, the negative family history for melanoma, and the absence of drugs and toxic exposure. Clinical follow‐up may be sufficient to monitor CMMT rather than performing a tongue biopsy.     

野生株肺炎克雷伯杆菌感染致剥脱性皮炎1例

患者男,56岁,全身皮疹伴高热2 d入院,体温持续39℃,躯干和四肢大量疱疹及斑丘疹,右眼结膜充血,有分泌物,舌苔白色假膜;WBC 25.82×10^9/L,CRP 42.11 mg/L,PCT 10.19 ng/mL,CD4值126个/μL,肌酐204μmol/L;CT示:右上中肺薄结节影;腹部MRI示肝结节;口腔白色念珠菌;皮肤病理见真菌孢子;单纯疱疹病毒及肺炎支原体IgM阳性,血和皮肤均培养出野生株肺炎克雷伯菌。诊断:①败血症;②剥脱性皮炎;③口腔及皮肤真菌感染。     

A case of sarcoidosis involving the tongue.

Sarcoidosis is a systemic granulomatous disorder which commonly affects the skin. Involvement of the tongue is rare; a review of the previous literature over the last 30 years revealed only six cases of sarcoidosis affecting the tongue. We studied a case of sarcoidosis involving the tongue in a 32-year-old Japanese woman with characteristic clinical and pathological findings. She visited our department with a complaint of a tongue lesion of which she had been aware for a month. A diagnosis of sarcoidosis was made for the lesion by clinical and pathological examinations. Oral involvement by sarcoidosis is rare, however this disorder should be considered as a possible cause of intraoral granulomatous lesions.     

Oral mucosa lesions as atypical manifestation of adult-onset Still’s disease

Adult-onset Still’s disease is a systemic inflammatory disorder of unknown etiology, characterized by skin rash, spiking fever, arthralgias or arthritis, and leukocytosis. The typical skin rash is evanescent, salmon-pink, nonpruritic and maculopapular, predominantly on the extremities. It is considered one of the major Yamaguchi’s criteria in adult-onset Still’s disease. However, atypical skin lesions are also described. Here, a 61-year-old woman with sore throat, spiking fever, polyarthritis and evanescent salmon-pink nonpruritic maculopapular skin rash on the extremities was diagnosed with adult-onset Still’s disease. In addition, atypical brown macules on oral mucosa, localized on the inner lips and tongue were also observed. Biopsy revealed a neutrophilic infiltrate. Despite treatment and improvement of the adult-onset Still’s disease, the atypical oral mucosal lesions persisted.     

Primary Systemic Amyloidosis with Unusual Dermatological Manifestations: A Rare Case Report

Amyloidosis is a group of heterogeneous diseases characterized by pathological deposition of proteinaceous substance extracellularly in various tissues. The clinical presentation depends on the site of amyloid deposition, with predominant involvement of mesenchymal elements and cutaneous findings in 30–40% of patients in case of primary systemic amyloidosis. We present a case of idiopathic primary systemic amyloidosis presenting with an unusual finding of nodulo-ulcerative lesion over tongue along with multiple skin-colored nodules, mimicking squamous cell carcinoma of tongue with secondary cutaneous metastasis, as well as lacking the classical presentation of purpura, macroglossia, waxy papules, and plaques.     

Ranitidine‐induced black tongue: A case report

Black tongue is a rare, benign, self‐limiting disorder caused by certain conditions and some medications. We report the first case of a child diagnosed with black tongue associated with ranitidine use. We report our case to emphasize the rare side effect of this frequently used drug. Health care professionals should be aware of the likelihood of ranitidine‐induced black tongue in clinical practice.     

原发性系统性淀粉样变病1例

报告1例原发性系统性淀粉样变病。患者男，39岁。1年前肩关节突然出现酸痛，症状渐渐加重，双手掌皮肤发硬，肢体上抬及下蹲困难，舌不能外伸，吞咽时有梗阻感。曾经患有胸椎椎体骨髓瘤。皮肤科检查示面颈部、双侧腋下、腹部、阴茎、双大腿内侧泛发对称性的蜡样半球形丘疹，有融合，呈肤色或琥珀色。口腔黏膜肥厚，舌弥漫性浸润、质硬，呈巨舌。皮损组织病理检查示表皮萎缩，真皮与皮下组织淀粉样物质沉积，甲基紫染色阳性，诊断为原发性系统性淀粉样变病。给予泼尼松和雷公藤治疗，症状明显改善。     

Raynaud's phenomenon with oral manifestation in systemic lupus erythematosus

A 24-year-old woman with discoid lupus erythematosus developed systemic lupus erythematosus after 6 years. One of the clinical features was Raynaud's phenomenon in the fingers and toes, and furthermore Raynaud's phenomenon appeared in the tongue when exposed to cold and windy weather.     

Traumatic lingual ulcer in a child: Riga–Fede disease

Riga–Fede disease RFD is an extremely rare, benign inflammatory disorder characterized by reactive, traumatic ulceration of the oral mucosa especially located on the tongue. It is most commonly associated with natal or neonatal teeth in newborns. Mucosal lesions are often caused by repetitive traumatic damage due to backward and forward motions of the tongue over the lower incisors. Failure to diagnose and treat these lesions properly may result in inadequate food intake, growth retardation and permanent lingual deformity. We report a 15-month-old healthy infant with tongue ulcer diagnosed as RFD based on history and clinical features.     

Effectiveness of vitamin A acid in diseases of the mouth mucosa: lichen ruber planus, leukoplakias and geographic tongue]

52 patients, with different pattern of oral lichen planus, pre-malignant leukoplakia or geographic tongue, were treated with vitamin A acid. The systemic medication resulted in regression of discrete papules and leukoplakia-like appearance of oral lichen planus. Linear-hypertrophic pattern of the oral mucosa showed distinct involution only by topical administration of vitamin A acid. Also the patients suffering from pre-malignant leukoplakia or geographic tongue partly improved after a vitamin A acid therapy. Systemic side effects were noted after ignoring the tolerance limit (30 mg/day vitamin A acid/3 weeks). Inflammation and occasionally maceration appeared when local treatment was used over 3 weeks. Recurrence was observed in 11 patients.     

Myeloma-associated systemic amyloidosis presenting with acquired digital cutis laxa-like changes

A 59-year-old woman presented with a 6-year history of lax skin on the distal fingers of both hands, as well as a recent increase in the size of her tongue. Histopathology of skin from her distal finger showed amyloid deposition and bone marrow biopsy revealed an underlying plasma cell dyscrasia. Initial treatment with cyclophosphamide, vincristine, adriamycin and methylprednisolone has produced a significant reduction in the swelling of both her hands and tongue. Acquired digital cutis laxa-like changes are a rare cutaneous manifestation of systemic amyloidosis.     

Lipoid proteinosis

A 20-year old male presented with hoarseness of voice since birth, beaded papular lesions on both eyelids, multiple hypopigmented atrophic scars on trunk and extremities and yellowish infiltrated plaques on tongue, palate and buccal mucosae. Patient was diagnosed clinically as a case of lipoid proteinosis. It was confirmed by mucosal biopsy.     

Spätsekundäre Syphilis mit Ulzeration der Zunge bei HIV-Koinfektion

With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.     

Punctate vascular papules on the tongue and scrotum

We report a 60-year-old man who presented with a 2-year history of painless red raised lesions involving the tongue and scrotum. Histopathology was suggestive of angiokeratoma. Oral angiokeratomas are most commonly found as a component of the generalized systemic disorder in Fabry's disease or fucosidosis. Our patient had isolated mucosal angiokeratomas which is very rare.     

Oral Hairy Leukoplakia Which Occurred as a Presenting Sign of Acute Myeloid Leukemia in a Child

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.