A 78-year-old woman visited our hospital with fatigue and tongue pain and swelling lasting 3 weeks. A physical examination revealed an ulceration with a whitish-yellow coating on the right side of the tongue and several erosions in the center (Picture 1). She also had bilateral palpable temporal arteries with mild tenderness. A laboratory examination revealed a white blood cell count of 18,200 /μL and erythrocyte sedimentation rate: 99 mm/h. Contrast-enhanced computed tomography showed wall thickening of the thoracoabdominal aorta (Picture 2, arrows) and the proximal brachiocephalic, left common carotid, and left subclavian arteries (Picture 3, arrows). A biopsy of the temporal artery with a histopathological examination confirmed the diagnosis of giant-cell arteritis. She was treated with glucocorticoids, which were markedly effective, healing the tongue lesions within four weeks. Giant-cell arteritis can induce tongue necrosis as a rare initial manifestation, presenting with tongue pain (80%), tongue edema (50%), or ulceration of the tongue (28%) (1,2).
Picture 1.
Picture 2.
Picture 3.
The authors state that they have no Conflict of Interest (COI).
Acknowledgement
We thank Dr. Masahiko Ezoe and Dr. Mariko Sakai from Saga University Hospital, Japan, for the clinical treatment of the patient. We also thank Dr. Kiyoshi Shikino from Chiba University Hospital, Japan, for kindly supporting this work. We thank Jane Charbonneau, DVM for editing a draft of this manuscript.
References
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