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Case Reports
. 2024 Nov 23;16(11):e74331.
doi: 10.7759/cureus.74331. eCollection 2024 Nov.

Black Hairy Tongue Observed During Esophagogastroduodenoscopy

Masaya Iwamuro  1 , Takehiro Tanaka  2 , Motoyuki Otsuka  1
Affiliations
Case Reports

Black Hairy Tongue Observed During Esophagogastroduodenoscopy

Masaya Iwamuro et al. Cureus. .

Abstract

Black hairy tongue, also known as lingua villosa nigra, is a benign oral condition characterized by a dark discoloration and "hairy" appearance on the tongue's dorsal surface, resulting from elongated filiform papillae. This condition is associated with risk factors such as smoking, poor oral hygiene, and diabetes, which increase susceptibility to microbial colonization, particularly by Candida species. Although commonly diagnosed by visual inspection, black hairy tongue is infrequently observed during endoscopic procedures. We report a case of a 69-year-old Japanese man with poorly controlled type 2 diabetes (hemoglobin A1c of 9.7%) and a significant smoking history of 49 pack-years. During a routine esophagogastroduodenoscopy, a dark lesion was detected on the dorsal surface of the tongue. Detailed imaging and biopsy revealed elongated papillae with fungal hyphae, confirming a diagnosis of candidiasis. This case underscores the value of esophagogastroduodenoscopy and histopathological examination in diagnosing black hairy tongue and distinguishing it from other pigmented lesions. Recognizing black hairy tongue as a potential finding during endoscopy may aid in prompt diagnosis, especially in patients with predisposing factors like smoking and diabetes.

Keywords: candidiasis; esophagogastroduodenoscopy; fungal infection; histopathology; pigmented lesions.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Endoscopic images of black hairy tongue.
(A) Endoscopic view of the tongue showing a black, protruding lesion (arrow) on the dorsal surface during esophagogastroduodenoscopy. (B) Close-up view under white light revealing elongated, dark papillae. (C) Narrow-band imaging further highlights the structure of the elongated papillae and the dark coloration.
Figure 2
Figure 2. Histopathological findings of the biopsy specimen.
(A) Hematoxylin and eosin (H&E) staining showing elongated papillae with numerous adherent hyphae, consistent with candidiasis. (B) Periodic acid-Schiff (PAS) staining confirming the presence of fungal hyphae, further supporting the diagnosis of candidiasis.
See this image and copyright information in PMC

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