We describe a 40-year-old lady who presents with a painful white tongue on exposure to the cold. The differential diagnosis and investigations are outlined with a discussion about this unusual presentation of a common problem.LEARNING POINTS • Raynaud's can affect areas of the body besides the digits.• Lingual Raynaud's should be considered in patients with transient tongue pain.• Alternative diagnoses should be sought if ulceration or permanent symptoms develop. KEYWORDS Raynaud's, tongue CASE DESCRIPTION A 40-year-old woman presented with intermittent, 20 minute episodes of sequential painful white and blue tongue discoloration upon exposure to the cold. The peripheral rim of her tongue was relatively spared and on re-warming, the tongue became bright red associated with a burning sensation. The episodes caused moderately severe discomfort with dysarthria and stiffness at the back of the tongue as well as hypersalivation. The patient had a past history of vitamin B12 deficiency and was a smoker. There was no concurrent digital vasospasm of fingers or toes, lips or nipples. She did not have a past medical history of any connective tissue disease. Physical examination was normal but the tongue colour change is shown in Figure 1. Laboratory testing was negative for anti-nuclear antibody and rheumatoid factor. Other blood investigations demonstrated no abnormalities in biochemistry, haematology, ESR or clotting profile.

Objectives: To determine the frequency of depression in patients with diabetes mellitus and comparison of the frequency of depression in patients with diabetes mellitus (type1 & 2). Study Design: Descriptive Cross-Sectional Study. Setting: Diabetic Clinic of Benazir Bhutto Hospital, Rawalpindi. Period: From 6th June - 5th December 2016. Material & Methods: A total of 200 patients with diabetes mellitus were inducted in the study through Diabetic Out Patient Department at Benazir Bhutto Hospital, Rawalpindi. Patients screening was done by using ICD10-criteria &Beck Depressive inventory (depression diagnosis and severity assessment). Designed proforma was used for demographic details and variables. The data was analyzed using SPSS version 16.0. Depression frequency and severity was calculated. Chi Square test was applied depression and categorical variables associations. Results: Frequency of depression in the study sample came out to be 57% (114 out of 200 patients). Results concluded that 26 patients have mild depression (13%), 38 (19%) moderate depression, and 24 (12%) with severe depression. There is no significant difference in frequencies of depression in terms of type of Diabetes mellitus i.e. T1DM vs T2DM (39% vs 61%, P value > 0.05). Monthly income and BMI were factors leading to mental distress. Conclusion: Many of the patients with diabetes have co-morbid depression. Screening and appropriate treatment of depression should be part of the management plan of all patients having diabetes.