Pathology · patient case question
What is the reason for her symptoms?
Patient case: Two-year history of tongue discomfort with spicy foods
Scenario: A female patient has had discomfort in her tongue for TWO YEARS. Spicy foods and some cold drinks bother her.
Show answer and explanation
Correct answer: B. Erythema migrans (benign migratory glossitis / geographic tongue)
- A. Median rhomboid glossitis is a single well-defined erythematous, papilla-free zone on the MIDLINE POSTERIOR dorsum, associated with candidal infection. It does not migrate.
- B. Correct. Erythema migrans presents as well-demarcated ERYTHEMATOUS PATCHES of filiform papillary atrophy surrounded by a raised white or yellow SERPIGINOUS border on the tongue dorsum. The pattern MIGRATES over days to weeks. Most patients are asymptomatic, but a substantial minority report burning or sensitivity specifically to SPICY, ACIDIC or hot foods — exactly as described.
- C. Oral lichen planus most often presents on the buccal mucosa bilaterally with Wickham's striae; the erosive form is painful but does not migrate.
- D. Burning mouth syndrome is burning pain with a CLINICALLY NORMAL mucosa — a diagnosis of exclusion. Here there are visible lesions.
Note: Erythema migrans is associated with FISSURED TONGUE and with psoriasis. It is entirely benign, and reassurance is a large part of management.