Lingua Villosa Nigra Following Initiation of Antibiotic Treatment for Multidrug-Resistant Tuberculosis

Treatment with bedaquiline, moxifloxacin, clofazimine, terizidone, and linezolid was initiated in a 51-year-old male cigarette smoker with multidrug-resistant pulmonary tuberculosis. At 29 days, he noticed brownish discoloration of the tongue (Figure). Due to the typical clinical picture, lingua villosa nigra, or “black hairy tongue” (BHT), was diagnosed. The hallmark of this disorder is hypertrophy of the filiform papillae due to abnormal, reduced desquamation. This gives the surface of the tongue a furry appearance. The discoloration is caused by porphyrin-producing chromogenic bacteria or yeasts and ranges from yellowish-brown to black. Poor oral hygiene, xerostomia, and tobacco use are known risk factors. An association with antibiotic treatments, often linezolid, has been reported. Although the pathophysiology of this association has not been fully elucidated, a change in the oral microbiome appears to play a role. The treatment of BHT primarily comprises intensive oral hygiene, mechanical cleaning, and the elimination of predisposing factors. The disease has a very good prognosis. No cases of severe, long-term damage or functional impairment to the tongue due to BHT have been reported in the literature.

Figure

Dr. med. Fabian Leo, Dr. med. Hannes Semper, Prof. Dr. med. Christian Grohé, Klinik für Pneumologie, Evangelische Lungenklinik Berlin, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Leo F, Semper H, Grohé C: Lingua villosa nigra following initiation of antibiotic treatment for multidrug-resistent tuberculosis. Dtsch Arztebl Int 2022; 119: 752. DOI: 10.3238/arztebl.m2022.0211