Raynaud's of the Tongue

Abstract

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.

Lingual Raynaud’s Phenomenon after Surgical and Radiotherapeutic Intervention for Oral Squamous Cell Carcinoma

“…Raynaud's phenomenon of the tongue is exceedingly uncommon and often occurs in the setting of primary Raynaud's disease of the digits. There have been at least 22 cases of lingual involvement reported in the literature, usually associated with systemic sclerosis, Sjögren's syndrome, or other connective tissue disorders [3][4][5][6][7][8]. Of the lingual Raynaud's cases found in the literature, four were identified without preexisting connective tissue disease all occurring after the use of radiotherapy for head and neck squamous cell carcinomas [2,[9][10][11].…”

“…Case Reports in Vascular Medicine with a previously diagnosed systemic sclerosis with digital Raynaud's symptoms [3][4][5][6][7][8].…”

Lingual Raynaud’s phenomenon: a rare presentation

“…Raynaud’s phenomenon of the tongue is rare, in part due to its excellent circulation 9. It has been most frequently described in patients with underlying autoimmune disease including systemic sclerosis,10 11 Sjogren’s syndrome12 and mixed CTD 13.…”

“…In some cases, sensory changes including numbness and tingling, have been described alongside lingual Raynaud’s phenomenon 10 14 16. Dysarthria has been reported in some case reports 9 10 12 14. Therefore, lingual Raynaud’s phenomenon is a differential diagnosis for neurological conditions, notably TIA, and careful history-taking is required to elicit the colour changes associated with the disorder.…”