Photo Quiz

Burning on the Tip of the Tongue

 

Am Fam Physician. 2018 Jan 1;97(1):47-48.

A 29-year-old woman with a history of oral herpes simplex virus presented with sore throat, cough, headache, fatigue, and a reported fever of 102°F (38.9°C). She had experienced malaise over the previous three weeks. Mouth lesions and a burning sensation when she drank hot tea developed about two days before presentation.

On physical examination, the patient was not in acute distress, and she had normal vital signs. She had mildly tender anterior and posterior cervical lymphadenopathy. Vesicular lesions were visible on the bilateral labial commissures, and the dorsal tongue had well-demarcated bare patches with raised erythematous borders (Figure 1). The tongue lesions seemed to change and migrate daily. She had no genital lesions.

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FIGURE 1


FIGURE 1

Laboratory findings included a negative rapid streptococcal test result and a nonreactive human immunodeficiency virus test, but a positive mononucleosis spot test result. A throat culture was positive for non–group A beta-hemolytic streptococcus.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Atrophic glossitis.

B. Behçet syndrome.

C. Burning tongue.

D. Geographic tongue.

E. Oral hairy leukoplakia.

Discussion

The answer is D: geographic tongue, also known as benign migratory glossitis. The condition often resembles a map of the world, hence its name.1 It is thought to be an inflammatory disorder of unknown etiology.2 Focal regions of papillary atrophy on the dorsum of the tongue lead to ulcer-like patches surrounded by serpiginous, erythematous borders. The patches can rapidly resolve and migrate.3 Geographic tongue affects 1% to 14% of the U.S. population and has an inverse correlation with smoking, but there is no clearly established association with a disease process.3

Geographic tongue is usually self-limited and requires no treatment. Some patients with geographic tongue may report tongue sensitivities to hot or spicy foods.4 Topical steroid gels and antihistamine mouth rinses may reduce sensitivity.3

This patient tested positive for mononucleosis and n

Author disclosure: No relevant financial affiliations.

Address correspondence to Thomas M. Skinner, MD, FAAFP, at thomas.skinner@us.af.mil. Reprints are not available from the authors.

References

show all references

1. Joseph BK, Savage NW. Tongue pathology. Clin Dermatol. 2000;18(5):613–618....

2. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. Am J Med. 2002;113(9):751–715.

3. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627–634.

4. Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract. 2005;6(1):123–135.

5. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet. 1990;335(8697):1078–1080.

6. Drage LA, Rogers RS III. Burning mouth syndrome. Dermatol Clin. 2003;21(1):135–145.

7. Triantos D, Porter SR, Scully C, Teo CG. Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance. Clin Infect Dis. 1997;25(6):1392–1396.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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