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There are some controversies over the pathogenesis and clinical features of median rhomboid glossitis. A case of median rhomboid glossitis associated with amyloid deposition was presented. Clinically there was no organ involved in amyloid other than the tongue. It was suspected that median rhomboid glossitis occurred first and that amyloid was induced later.
A series of twenty-eight cases of median rhomboid glossitis were studied histologically. Of these twenty-eight cases, 85 percent showed fungal hyphae in the parakeratin layer. The literature is reviewed, and additional evidence is presented to support the theory the median rhomboid glossitis is not a developmental condition but the clinical expression of a localized chronic fungal infection.
The etiology and pathogenesis of median rhomboid glossitis have been subjects of controversial discussions for a long time. In recent years, the possible role of Candida albicans has been stressed. The findings in 18 patients with median rhomboid glossitis only support partly the hypothesis of Candida albicans being an important etiologic factor.
The median rhomboid glossitis is generally considered as a developmental anomaly of the tongue. Recent clinical, biological and experimental studies provide support for a fongous etiology: this lesion of the midline of the tongue is a chronic hyperplastic oral candidiasis, occurring sometimes in association with candidal commissural leukoplakias and palatine kissing lesions. The yeasts--mainly Candida albicans-- invade the upper parakeratotic layers of the epithelium inducing a proliferating acanthosis of the deeper epithelial ridges; superficial micro-pustules closely related to the candidal hyphae were found in most cases. Antifungal specific therapy appear effective in early lesions; later the condition becomes permanent and, in a few cases, may go further to malignant change. Fourteen cases are presented in this paper: the clinical, histopathological and therapeutic features are obviously in accord with this fongous infectious etiology (already suggested and demonstrated in 1965 by French stomatologists) and with the more recent experimental data published by Cawson, Sohnel and Kirkpatrick, Jones and Russell.
A case of glossitis calcinosa in a dog caused by Pasteurella multocida is reported. Swelling of the tongue and reduced appetite were the predominant clinical symptoms. Due to latent infections with P. multocida in many species there is a risk of bitewounds being infected with this microorganism. In order to find the carrier-rate of P. multocida samples in canines, teeth and gingiva of 121 dogs and 30 cats were examined bacteriologically, revealing a carrier rates of 55% and 80% respectively. The rate is significantly higher in dogs with poor oral hygiene (calcula), and there is a tendency towards small dogs being more at risk than large dogs and male cats more than females. The isolated strains of P. multocida were most sensitive to chloramphenicol and tetracycline whereas, many were resistent to penicillin and sulfa. The theory, that this pattern should be explained by the common use of the latter drugs in veterinary practice, is not valid under Danish conditions, where chloramphenicol and tetracycline are commonly used in the small animal clinic. Accordingly suspected P. multocida infections should be treated with chloramphenicol or tetracycline, until the result of a sensitivity test is available, and not with penicillin which today is the general routine.
A 17-year-old white boy with signs, symptoms, and family history of angiokeratoma corporis diffusum universale, Anderson-Fabry disease (AFD), developed recurrent and then persistent swelling of both lips, erythematous hyperplastic gingivae, and a pebbled tongue. Positive blood findings were raised serum IgE, decreased T-cell level, and increased B-cell level. Histopathology of the gingiva showed noncaseating granulomas with multinucleate giant cells containing Schaumann bodies and large plasma-cell infiltrates in which immunofluorescence demonstrated immune globulins of several classes. Electron microscopy and histochemistry demonstrated ceramide in the vasculature. No glycolipid was found in the macrophages or giant cells of the granulomas which, in contrast, resembled sarcoid reactions. Plasma cells with Russell bodies and immune reaction-induced degranulation of mast cells were also identified. The pathogenesis of the oral findings possibly relates to altered immune reactivity associated with damage to the microvasculature analogous to that in Melkersson-Rosenthal syndrome.
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Thirty piglets 1 to 4 weeks old from five herds had epidermal, foot, conjunctival and renal lesions typical of exudative epidermitis. Ten piglets had a large central ulceration of the dorsum of the tongue. Three piglets had multiple erosions of the hard palate and one had mucoid degeneration of the urinary bladder epithelium and a thick viscous material in the renal pelvis, ureters and urinary bladder.
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1. A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61% had pyridoxine deficiency, and 9.4% had thiamin deficiency as judged by enzymic tests. 2. The prevalence of angular stomatitis was 41.3% and that of glossitis was 18.2%. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children with angular stomatitis with or without associated glossitis, than in children without oral lesions. 3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for 1 month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4. Small but significant changes in erythrocyte enzymes occurred over the period of 1 month even without vitamin supplements. 5. Results suggest that while glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency or both, angular stomatitis has a more complex aetiology perphaps associated with infection.
In accordance with the system of viral species, viral disorders of the oral mucosa may be classified with regard to their intensity of affection. There are but few viral infections exclusively affecting the oral mucosa like e.g. 1. Glossitis papulosa of Michelson, representing a special form of vaccinia inoculata, 2. Gingivo-stomatitis herpetica and 3. warts of the mucosa or condyloma-like papillomas of the oral mucosa including oral papillomatosis, that, itself shows morphological and clinical similarities to laryngeal papilloma. A second group of disorders mainly affecting the oral mucosa includes the "Aphthoid of Pospischill and Feyrter", Zahorsky's herpangina and other viral infections by the Coxsackie group, like vesicular stomatitis. The 3rd group represents viral infections of other organs in which affection of the oral mucosa is a prerogative, e.g. smallpox, varicella, foot-and-mouth disease and pharyngo-conjunctival fever. A 4th group includes those viral infections of the organs in which co-affection of oral mucosa occurs frequently or once in a while (at occasions). Here, we find eczema vaccinatum, herpes zoster, herpes simplex of the oral mucosa mostly on the hard palate, eczema herpeticatum, post-herpetic Erythema exsudativum multiforme, Mononucleosis infectiosa Pfeiffer, viral flu, German measles, parotitis epidemica, rubeola and ECHO-exanthema. A 5th and last group is made up by viral infections of other organs, in which affection of the oral mucosa hardly occurs at all. This group contains paravaccinal Ecthyma contagiosum, poliomyelitis, viral infection of the city of Marburg and some Arbovirus infections. Relatively few viral disorders never co-exist with lesions on the oral mucosa like e.g. Virus-hepatitis or some viral encephalitides. Groups 1 and 2, most important of all, are presented in detail regarding clinics, diagnostics, differential-diagnosis and therapy. The disorders within the other 3 groups are discussed only regarding their importance in the field of ENT-related symptoms of the oral mucosa. A number of pictures and tables completes important clinical details and give further hints to their differential-diagnosis.
Sixteen cases of plasma-cell gingivostomatitis were studied at the University of California San Francisco between 1966 and 1971. Twelve women and four men made up the group, with ages ranging from 15 to 70 years. Prior to treatment, the duration of the disease ranged from 5 to 60 months. Each of the sisteen patients manifested a homogeneous, diffuse, erythematous gingivitis associated with a cheilitis, and fifteen also had a marked glossitis. Each subject was symptomatic, and nine also complained of bleeding. Every biopsy specimen demonstrated a characteristically diffuse and dense plasma-cell infiltrate. There were no spontaneous remissions. Six patients completely responded to systemic corticoids alone, two to discontinuation of gum chewing or the use of their dentifrice, one to antifungal therapy, and the other seven to a combination of the preceding modalities. After completion of therapy, fifteen patients were followed for 2 to 55 months without any evidence of recurrence. Of interest, 69 per cent were gum chewers. The therapeutic benefit of discontinuing gum chewing by itself was not clear. It is assumed that the now nonexistent plasma-cell gingivostomatitis syndrome was a hypersensitivity response to an unidentifiable antigen used in various substances.
A case of glucagonoma syndrome with necrolytic migratory erythema, glossitis, anemia, hyperglucagonemia and a malignant, pancreatic A-cell tumour in a 68-year-old male is described. Gel filtration of the highly elevated circulating glucagon immunoreactivity (2200 pg/ml) demonstrated 60% pancreatic glucagon and 30% "proglucagon". Metabolic studies before operation demonstrated suppression of the total plasma glucagon concentration on oral glucose tolerance test, unchanged total plasma glucagon concentration during intravenous glucose tolerance test and insulin-induced hypoglycemia. Administration of arginine was followed by a rise in both the pancreatic glucagon and the "proglucagon", whereas alanine increased only the pancreatic glucagon. The plasma somatostatin level was immeasurable preoperatively. Somatostatin infusion completely suppressed the release of the pancreatic glucagon but did not significantly affect the "proglucagon". After removal of the tumour the skin lesions disappeared and the total plasma glucagon values fell to normal levels (120 pg/ml). Also, other abnormal laboratory findings returned to normal, including the preoperatively observed renal glucosuria.
Central papillary atrophy and other anomalies of the tongue were studied among 175 diabetic outpatients attending the Tygerberg Hospital. Atrophic lesions of the tongue were found in 26.9% of the patients and 91.7% of these lesions were central papillary atrophy. The degree of control of the diabetes as measured by plasma glucose and urine analyses was not related to the frequency of central papillary atrophy. The prevalence of central papillary atrophy in diabetics was found to be much higher than that of central papillary atrophy and median rhomboid glossitis found in previous investigations among other populations. It is suggested that patients with central papillary atrophy should be screened to rule out diabetes mellitus as the underlying cause. Double central fissures, producing well demarcated triangular areas with their bases at the "sulcus terminalis", were seen in nine instances (5.1%). Four of these areas were associated with central papillary atrophy; the remaining five were covered by non-atrophic mucosa with filiform and fungiform papillae.
Adult cotton top marmosets made niacin deficient by long-term dietary deprivation, developed a syndrome characterized by anorexia, weight loss, weakness, diarrhea, dermatitis, enterocolitis and stomatitis. The stomatitis was highlighted by a necrotizing gingivitis and periodontitis and by an ulcerative and atrophic glossitis.
Clinical observations on two cases of staphylodermia superficialis circinata are reported. This rare variation of superificial staphylococcal skin infection is identical with the "erythema necroticans migrans". As this cutaneous manifestation is highly associated with malignant internal diseases it must be regarded as a "cutaneous paraneoplasia". Out of 14 cases of erythema necroticans migrans, so far published this dermatosis occured in 13 patients suffering from pancreatic cancer. Association with pancreatitis was demonstrated in one case. In both cases herein reported the cutaneous manifestations were associated with a carcinoma of the pancreas and with cervix cancer. Extreme loss of weight, atrophic glossitis, therapy-resistant anemia and a slight diabetes are extra-cutaneous symptoms of this paraneoplastic syndrom.