Dr. Mehak Agarwal
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have an issue with my tongue pain for about one month. I am having this issue where my tongue is red in the middle and painful when it is pushing around spit or food or when it is pushing itself to the roof of the mouth. I have a burning sensation. It is hardly noticeable in the morning but by evening it is irritating and it hurts again. The tongue is also much whiter than normal and it retains the colors of what is eaten. For example, something red stains the tongue. There is no pain when talking or when the tongue is simply resting. I have been to an ENT specialist recently for this. Diagnosis is median rhomboid glossitis caused by suspected candidiasis. This is pending culture. I am currently on Voriconazole 200 mg two times daily for 14 days. I am on the verge of completing the course, but I see no results. I had a similar issue last year but it did not look like this. I ended up having strep which may have caused the issue. So, I had a rapid strep test which came back negative. I have also been to a general practician and got Nystatin swish and swallow for seven days with no results. I was then put on Diflucan for 14 days, yet no results. I have a past history of ulcerative colitis which is controlled. I am currently using Humira for colitis (one pen) twice monthly. I am also on Zyrtec one daily, Prilosec 20 mg daily for heartburn, and a daily multivitamin. I am looking for a second opinion as my doctor is perplexed. I have attached pictures for your reference. Please help.
Hello,
Welcome to icliniq.com.
I have gone through the images (attachment removed to protect patient identity). Your tongue does not look diseased to me. The diagnosis made by the ENT (ear, nose, and throat) physician seems to be fine. Due to some changes in the papilla present on the tongue, your tongue looks little different but it is not infected since you have already sent for culture. We will wait for the reports. I suggest you need not even take antifungal for the tongue. Let us wait for the reports. But since I think as you have already started them, you need to finish the course. You may continue your treatment for ulcerative colitis and also start Chlorhexidine Gluconate mouth gargles four times daily which will reduce the whiteness of the tongue. A lot of drugs like Humira can cause changes in the papilla of the tongue. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.
Patient's Query
Thank you doctor,
The culture has come back negative. The doctor has advised me to finish the medication anyway and to report back once done. If not better, he will need a biopsy. I do not know what else it could be? If Humira is causing it then I will discuss this with the GI at my next appointment. Kindly suggest what should be done.
Hello,
Welcome back to icliniq.com.
I was sure that the culture reports will be normal and also I am also sure that the biopsy will also be normal. Your tongue is normal and you need not worry about it. I suggest you start Chlorhexidine Gluconate mouth gargles. Continue antacids and multivitamins. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.
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Otolaryngology (E.N.T)
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