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November 5, 2018

Image challenge: An uncommon clinical sign in a patient with ulcerative colitis

What caused a striking black coloration in the dorsum of the tongue of a 61-year-old female smoker? 

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Gastroenterology clinical image challenge: A 61-year-old female smoker was admitted due to a febrile syndrome, asthenia and productive cough for three weeks. She was previously treated for a respiratory tract infection with amoxicillin-clavulanate without improvement. Her past medical history included ulcerative colitis in clinical remission on anti-tumor necrosis factor-α therapy (infliximab). Physical examination revealed a striking black coloration in the dorsum of the tongue that presented abnormal elongated and hypertrophic phylliform papillae and a hairy appearance (figure). No pain or gustative changes were noted. Laboratory data showed significant elevation of acute phase markers and hypoxemia, thorax computed tomography scan was suggestive of bronchopneumonia and a Haemophilus influenza was isolated in respiratory secretions. The patient completed a seven-day course of intravenous ceftriaxone and topical miconazole brushing. Respiratory symptoms resolved and the tongue discoloration gradually disappeared. Infliximab therapy was resumed without further complications. In addition, the patient was referred to a smoking cessation consult.


What is the correct semiological designation for the striking clinical feature present in the figure?


To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.


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