Median Rhomboid Glossitis

September 14, 2005
Robert P. Blereau, MD

A 35-year-old woman complained of pain or a burning sensation on her tongue when she ingested hot or acidic food and beverages. The white patch had spontaneously developed on her tongue 3 months earlier.

A 35-year-old woman complained of pain or a burning sensation on her tongue when she ingested hot or acidic food and beverages. The white patch had spontaneously developed on her tongue 3 months earlier.

The narrow midline white linear ulceration at the posterior tongue dorsum measured approximately 0.5 cm × 2.0 cm. The patient was referred for an ear, nose, and throat consultation; median rhomboid glossitis was diagnosed based on the lesion's appearance-no biopsy was performed.

Robert P. Blereau, MD of Morgan City, La, comments that this lesion also may be termed “central papillary atrophy” because of the loss of lingual papillae. For many years, median rhomboid glossitis was thought to be a developmental lesion in which the lateral processes of the tongue failed to cover the midline tuberculum impar. This seems unlikely, however, since the condition is seen almost exclusively in adults.

Current thinking holds that median rhomboid glossitis is a chronic candidal infection, since Candida albicans can be seen on smears of material cultured from the lesions. Antifungal therapy may be effective.

Immunologic evaluation, including testing for HIV infection, is warranted if the lesion recurs. The patient can be reassured that median rhomboid glossitis is not premalignant.

Corticosteroid paste to decrease inflammation was prescribed for this patient. The condition resolved quickly and completely; it has not recurred.

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