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Age and Ageing Advance Access originally published online on December 3, 2007
Age and Ageing 2008 37(1):119; doi:10.1093/ageing/afm181
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Clinical Reminder

Tongue necrosis: a rare presentation of temporal arteritis

Atul Kusanale*, Henry Boardman and Hiro Khoshnaw

Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK

* To whom correspondence should be addressed Email: lycaon{at}doctors.org.uk

An 86-year-old woman presented with dysarthria and a painful tongue that looked dark and swollen and turned pale and offensive a few days later (Figure 1). Though the ESR was only 25 a strong clinical suspicion of giant cell arteritis led to an urgent referral for temporal artery biopsy. She was commenced on steroids whilst awaiting the biopsy, which was definitive.


Figure 1
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  		Figure 1. Note the extent and demarcation between the necrotic looking tissue and the relatively healthy tongue tissue.

 
Owing to dysphagia she proceeded to have a percutaneous endoscopic gastrostomy tube inserted. Surgical intervention was avoided due to her general frailty and other comorbidities. Despite the loss of tongue tissue she recovered well and attained near-normal speech and function.

Temporal arteritis is the most common cause of tongue necrosis and can masquerade in various forms [1]. High dose of steroids remains the treatment of choice followed by maintenance dose for a couple of years [2]. Benefit of heparin and nitroglycerine infusion is equivocal [3].


   Conflicts of interest
 
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   References
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 References
 

  1. Rockey JG, Annand R. Tongue necrosis secondary to temporal arteritis: A case report and literature review. Oral Surg Oral Med Oral Radiol Endod (2002) 94:471–73.[Web of Science][Medline]
  2. Marcos O, Cebrecos AI, Preito A, et al. Tongue necrosis in a patient with temporal arteritis. J Oral Maxillofac Surg (1998) 56:1203–06.[CrossRef][Web of Science][Medline]
  3. Bondeson J, Ericsson UB, Falke P, et al. Tongue necrosis in temporal arteritis provoked by ergotamine. J Intern Med (1992) 232:541–44.[Web of Science][Medline]

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This Article
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