Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2020;10(1):e2020020 1

Dermatology Practical & Conceptual

Case Presentation

An otherwise healthy 20-year-old man presented to the emer-

gency department with a 5-day history of low-grade fever and 

malaise, followed by the appearance of painful lesions on his 

tongue. Physical examination revealed marked alterations 

of the tongue (Figure 1), including hyperplasia of fungiform 

papillae on the tip, white hairy tongue on the dorsum, fissured 

tongue on the lateral borders, and multiple small, coalescing 

ulcerations with scalloped borders and erythematous rim. 

Only 1 similar erosion was found on the lower lip and 1 on 

the hard palate, and gingivae were spared. Polymerase chain 

reaction of an ulcer swab was positive for herpes simplex 

virus, type 1, allowing the diagnosis of an atypical form of 

herpetic gingivostomatitis.

Teaching Point

Herpesvirus family has a broad spectrum of mucocutaneous 

manifestations. Multiple oral ulcerations with scalloped bor-

ders should raise the suspicion of herpetic gingivostomatitis, 

even if typical involvement of keratinized mucosa is absent.

Catastrophic Tongue
Juan Jimenez-Cauhe,1 Sandra Dominguez-Carames,2 Daniel Ortega-Quijano,1  

Diego Fernandez-Nieto1

1 Servicio de Dermatología, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain

2 Servicio de Otorrinolaringología, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain

Key words: herpesvirus, oral ulcers, gingivostomatitis, tongue

Citation: Jimenez-Cauhe J, Dominguez-Carames S, Ortega-Quijano D, Fernandez-Nieto D. Catastrophic tongue. Dermatol Pract Concept. 
2020;10(1):e2020020. DOI: https://doi.org/10.5826/dpc.1001a20

Accepted: August 22, 2019; Published: December 31, 2019

Copyright: ©2019 Jimenez-Cauhe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are 
credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Juan Jimenez-Cauhe, MD, Dermatology Department, Ramon y Cajal University Hospital. Carretera Colmenar Viejo 
km 9.100, 28034 Madrid, Spain. Email: jjimenezc92@gmail.com

Figure 1. Clinical image showing hyperplasia of 

fungiform papillae on the tip, white hairy tongue on 

the dorsum, fissured tongue on the lateral borders, 

and multiple small, coalescing ulcerations with scal-

loped borders and erythematous rim.

A B

mailto:jjimenezc92@gmail.com