Images in Clinical Medicine: Atrophic Glossitis

Summary

  • 64yo M
  • presented to oral medicine clinic
  • c/c
    • painful, smooth, red tongue
    • burning sensation around lips
      • 6mo
  • PEx
    • tongue
      • atrophic
      • erythematous
      • lingual papillae(–)
    • NeuroEx
      • np
  • Ex
    • L/D
      • Hb 13.7 (13.1-16.6)
      • MCV 101.5 fl (83.0-95.5)
      • vit.B12 < 37pmol/L (50pg/mL) (135-675 pmol/L (180-910pg/mL))
      • folate nl
      • anti-IF autoAb(+) 60U/mm
      • anti-gastric parietal-cell autoAb 16U/mL
  • Dx
    • pernicious anemia
  • Tx
    • intramuscular injection of vit.B12

Further

Terminology

Original

Figure

A 64-year-old man presented to the oral medicine clinic with a painful, smooth, red tongue and a burning sensation around his lips that had developed 6 months earlier. Physical examination revealed an atrophic, erythematous tongue with loss of the lingual papillae (Panel A). No deficits were found on neurologic examination. Laboratory results revealed a hemoglobin level of 13.7 g per deciliter (normal range, 13.1 to 16.6) and a mean corpuscular volume of 101.5 fl (reference range, 83.0 to 95.5). The serum vitamin B12 level was less than 37 pmol per liter (50 pg per milliliter; reference range, 135 to 675 pmol per liter [180 to 910 pg per milliliter]). The serum folate level was normal. Test results for anti–intrinsic factor autoantibodies were positive, with a titer of 60 U per millimeter, and the titer for antigastric parietal-cell autoantibodies was 16 U per milliliter (both titers are considered negative at levels of <20 U per milliliter). A diagnosis of pernicious anemia was made. Treatment with weekly intramuscular injections of vitamin B12 was initiated. The patient’s oral symptoms abated after 2 weeks of treatment, and the atrophic glossitis had resolved by the time of follow-up at 1 month (Panel B). The patient’s vitamin B12 level increased, and he continues to receive monthly injections.