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Median rhomboid glossitis associated with fungi
1 Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan
2 Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
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Takeshi Onda
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo 101-0061,
Japan
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Article ID: 100121Z06TO2023
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Onda T, Hayashi K, Katakura A. Median rhomboid glossitis associated with fungi. Case Rep Int 2023;12(2):15–16.ABSTRACT
No Abstract
Keywords: Fungi, Glottis, Hyphae, Tongue
CASE REPORT
A 50-year-old man without relevant medical history complained of a burning sensation on the tongue. Intraoral examination revealed erythema on the central dorsum of the tongue (Figure 1). Microscopic examination of the smear showed fungal hyphae. We made a diagnosis of median rhomboid glossitis (MRG) based on the characteristic gross findings, site of occurrence, and presence of fungi. The patient was prescribed an antifungal agent and instructed to maintain oral hygiene. Itraconazole (100 mg/day) was administered orally for 14 days. After one month, the mucosa regained its normal texture and the subjective symptoms were alleviated.
DISCUSSION
Median rhomboid glossitis is usually characterized by atrophy of the papillae just anterior to the terminal sulcus of tongue [1]. Most cases are asymptomatic, but some patients may complain of persistent pain, burning, and pruritus [1]. There are no objective diagnostic criteria for this disease and diagnosis relies on visual identification. Although the etiology of this disease is unclear, it has been suggested to be associated with smoking, poor denture fitting, immunosuppressants, diabetes, and broad-spectrum antibiotics [2]. Median rhomboid glossitis has previously been described as a congenital abnormality of the tongue that develops due to failure of the tuberculum impar to fuse with the two lingual swellings during embryogenesis with a resultant rhomboid depapillated area [3] . Recently, its occurrence has been thought to be associated with fungal infection [3],[4]. In general, this condition requires no treatment; however, if the fungal test results are positive, antifungal agents are administered and progression of the lesion is observed. Malignancy should be ruled out through biopsy if MRG is associated with erosion, vitiligo, and/or proliferative changes [5]. In the present case, fungus was detected in a sample collected by scraping the back of the tongue, and MRG associated with fungus was diagnosed. Good progress was made with the use of antifungal agents.
CONCLUSION
Median rhomboid glossitis is a noninflammatory disease rather than a true inflammatory condition. It is thought to be due to residual unpaired nodules that normally atrophy during fetal life. However, since the disease is less common in children, other causes have been postulated. Recently, fungal infection has been considered a possible cause. There are often no subjective symptoms, but redness and pain due to secondary inflammation may be present. Generally, no treatment is required. Symptomatic treatment is given when secondary inflammation occurs. If fungal infection is a contributing factor, antifungal agents are used.
REFERENCES
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Pili FMG, Erriu M, Piras A, Garau V. Application of the novel method in the diagnosis and treatment of median rhomboid glossitis Candida-associated. Eur J Dent 2014;8(1):129–31. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
Takeshi Onda - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Kamichika Hayashi - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Akira Katakura - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Takeshi Onda et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
