Painful diamond-shaped tongue lesion in elderly man

• Published in: The Clinical Advisor : For Nurse Practitioners Vol. 20; no. 4; pp. 41 - 45
• Main Author: Jenkinson, Helena
• Format: Magazine Article Trade Publication Article
• Language: English
• Published: Hawthorne Haymarket Media, Inc 01.04.2017
• Subjects: Elderly; Interleukins; Monoclonal antibodies; Mycoses; Psoriasis; United States > US
• ISSN: 1524-7317

A 62-year-old white man with a past medical history of latent tuberculosis, vitiligo, and psoriasis presents for follow-up for treatment of psoriasis. The patient's psoriasis has proven refractory to numerous treatments over the years, so he began treatment with secukinumab, a monoclonal antibody against interleukin-17A. After 2 months of therapy, the patient reports new-onset tongue pain. Physical examination demonstrates an erythematous, edematous, diamond-shaped plaque on the posterior dorsum of the patient's tongue. Median rhomboid glossitis (MRG), also known as central papillary atrophy and posterior midline atrophic candidiasis, refers to well-demarcated regions of depapillation on the dorsal tongue, typically occurring midline, anterior to the foramen cecum. Although generally asymptomatic, patients with MRG may present with pain or pruritus. MRG may also involve a similar erythematous lesion, known as a "kissing lesion," on the overlying palate, where it comes in contact with the tongue. The condition was once believed to be caused by failure of the lateral processes to properly fuse over the tuberculum impar of the tongue during embryogenesis, resulting in a region prone to Candida infection. However, authors today more commonly ascribe the lesions to Candida albicans infection alone.