Temporal arteritis presenting with tongue necrosis

Abstract

Spontaneous glossodynia is uncommon and glossodynia progressing to necrosis is especially rare. Although the commonest cause of lingual necrosis is giant cell arteritis, only a few cases of a new diagnosis of giant cell arteritis, clinically presenting with isolated lingual necrosis, have been reported.

Figure 1

Initial progression of lingual necrosis despite medical therapy (A, B) followed by surgical resection of necrotic tissue (C) and subsequent clinical improvement (1D). (A) Appearance of tongue at initial presentation. (B) Day 8 of hospital admission: well-demarcated area of grey/white discolouration of tip of tongue with slough. (C) Day 8: surgical debridement of tongue tissue (intraoperative). (D) Appearance of tongue at outpatient follow-up 28 days after initial presentation.

Figure 2

Histological appearance of tongue (A) and temporal artery biopsy (2B, C). (A) Resected  tongue tissue showing non-specific ischaemic changes and areas of infarction with marked ulceration and distortion of normal tissue architecture. (B, C) Temporal artery biopsy showing extensive transmural infiltrate of lymphocytes and histiocytes (black frame) with characteristic giant cells (thick arrows), extending into the adventitial tissues. A thrombus occluded the vessel lumen (thin arrow).