A recently adopted 4-year-old presents with geographic tongue and tongue swelling. What is the MOST likely cause?

Correct answer: D. Malnutrition

• A. Incorrect. Amyloidosis is a rare adult disease causing macroglossia — not typical for a recently adopted 4-year-old.
• B. Incorrect. Pernicious anemia causes atrophic glossitis (smooth, red, sore tongue), not geographic tongue with macroglossia.
• C. Incorrect. Benign migratory glossitis alone does not explain the tongue swelling.
• D. Correct. In a recently adopted child with geographic tongue AND tongue swelling, malnutrition is the most likely unifying diagnosis. Geographic tongue can be associated with nutritional deficiencies, and macroglossia in a neglected/deprived child points to malnutrition.