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[Tongue necrosis under corticosteroids].

L Ory¹, C D'Hauthuille, D Boutoille

¹Service de chirurgie maxillofaciale et stomatologie, CHU Hôtel-Dieu, 44000 Nantes, France. ory.laurent@wanadoo.fr

Revue De Stomatologie Et De Chirurgie Maxillo-Faciale

|January 22, 2008

Summary

A rare herpetic infection mimicking Horton disease caused a painful tongue ulcer in a corticosteroid-treated patient. Prompt diagnosis and antiviral treatment led to recovery, highlighting the importance of considering herpetic infections in such cases.

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Area of Science:

Oral Medicine
Infectious Diseases
Dermatology

Background:

The tongue is a frequent site for necrotic injuries associated with Horton disease.
Herpetic lesions can present with symptoms similar to Horton disease, complicating differential diagnosis.
Corticosteroid therapy for Horton disease may alter lesion presentation.

Observation:

A 67-year-old woman on corticosteroids for Horton disease developed a deep, painful, necrotic tongue ulcer.
The ulcer's progression despite ongoing treatment prompted a biopsy.
Biopsy revealed a herpetic infection, not a recurrence or complication of Horton disease.

Findings:

Herpetic infection can manifest as a necrotic tongue ulcer, mimicking Horton necrotic injuries.
This presentation is unusual, particularly in patients undergoing corticosteroid treatment.
Antiviral therapy with valacyclovir was effective in resolving the herpetic lesion within 15 days.

Implications:

Clinicians should consider herpetic infections in the differential diagnosis of necrotic tongue lesions, even in patients with presumed Horton disease on corticosteroids.
The case highlights the diagnostic challenge posed by atypical presentations of herpetic stomatitis.
Early diagnosis and appropriate antiviral treatment are crucial for managing such conditions.