THE CASE

THE CASE: A young child is brought to your office with a several-dayhistory of earache, sore throat, and low-grade fever. The nurse is concernedabout lesions she noticed on the child's tongue while attempting to take histemperature.

Which of the choices below describes the patient's condition?

• Contact stomatitis.
• Hyperplastic candidiasis.
• Geographic tongue.
• Lichen planus.
• Chemical burn.

DISCUSSION: The child has geographictongue, an inflammatory disorderalso known as benign migratoryglossitis, wandering rash tongue,and glossitis migrans. This benigncondition affects 2% to 3% of the population.More commonly seen inadults, it may also be found in children;the male to female ratio is 2:1.

Although the cause of the conditionis unknown, a variety ofagents have been associated with it,including tobacco, citrus fruits orother local irritants, alcohol, andspicy foods. Polygenic inheritancehas also been suggested.

The lesions of geographic tongueare usually restricted to the dorsumand lateral borders of the tongue.Three patterns have been described.One consists solely of patchy areas ofdesquamated or denuded filiformpapillae shown in the opening Figure(previous page). The others, in additionto patchy areas, show either:

• Inflamed lesions with slightly elevatedwhite C-shaped borders, or
• Red patches with or without whitecircinate lines, outlined by an erythematousband of inflammation as shownin the Figure above.

Combinations of these 3 types oflesion may exist concurrently. Patientsare often asymptomatic. Thosewith glossodynia (pain in the tongue)may be treated with topical corticosteroidsand anesthetics. The lesionsmay wax and wane, although the conditionis chronic.

The patient in this case had thehereditary form of benign migratoryglossitis from birth. The earache,sore throat, and low-grade fever weresecondary to viral pharyngitis, whichwas treated symptomatically.