Share:
Image Letter

Catastrophic Tongue

Author Affiliation(s)

Case Presentation

An otherwise healthy 20-year-old man presented to the emergency department with a 5-day history of low-grade fever and malaise, followed by the appearance of painful lesions on his tongue. Physical examination revealed marked alterations of the tongue ( Figure 1 ), including hyperplasia of fungiform papillae on the tip, white hairy tongue on the dorsum, fissured tongue on the lateral borders, and multiple small, coalescing ulcerations with scalloped borders and erythematous rim. Only 1 similar erosion was found on the lower lip and 1 on the hard palate, and gingivae were spared. Polymerase chain reaction of an ulcer swab was positive for herpes simplex virus, type 1, allowing the diagnosis of an atypical form of herpetic gingivostomatitis.

Figure 1 .

Clinical image showing hyperplasia of fungiform papillae on the tip, white hairy tongue on the dorsum, fissured tongue on the lateral borders, and multiple small, coalescing ulcerations with scalloped borders and erythematous rim.

Teaching Point

Herpesvirus family has a broad spectrum of mucocutaneous manifestations. Multiple oral ulcerations with scalloped borders should raise the suspicion of herpetic gingivostomatitis, even if typical involvement of keratinized mucosa is absent.

Send mail to Author


Send Cancel