Вы находитесь на странице: 1из 2

E-ISSN :0975-8437 P-ISSN: 2231-2285

CASE REPORT
Atrophic glossitis; an indicator of iron deficiency anemia : report of three cases
Veena Raju, Anjana Arora, Shweta Saddu

ABSTRACT
Atropic glossitis of tongue is considered as one of the signs of nutritional deficiency anemias. Tongue de-papillation
can be present with or without other clinical manifestations of iron deficiency anemia leading to diagnostic dilemma.
This paper report three cases of atrophic glossitis associated with iron defieciency anemia.
Keywords: Anemia; Atrophic; Glossitis; Iron Deficiencey Anemia

Introduction margins was present over anterior 1/3 of dorsum and right lat-
eral margin of tongue (Figure 2). Filliform papillae were absent
Atrophic glossitis (AG) is an inflammatory disorder of the with inter-dispersed prominent fungiform papillae. Based on
tongue mucosa that shows a smooth, glossy appearance with these findings, a provisional diagnosis of dentinal hypersensi-
a red or pink background.1,2 Atrophy of the papillae, muco- tivity in relation to 11, 21, 22 due to erosion and atrophic glos-
2014 Volume 6 Issue 3

sa, and dorsum of the tongue are considered classical signs sitis was made. Gastric disease involvement was ruled out due
of nutritional deficiencies.3 Absence of filiform or fungiform to absence of any history of regurgitation of food or dental
papillae involving more than 50% surface area of dorsum of erosion on palatal surfaces of upper anterior teeth. Differential
tongue gives rise to a soft aspect, known as atrophic glossitis diagnosis of nutritional deficiency anemia, median rhomboid
or smooth tongue.3 Clinically, iron deficiency anemia progress- glossitis, geographic tongue were considered. Following this,
es slowly, and symptoms include fatigue, light-headedness, the patient was enquired about history of lethargy, weight
cramps in legs weakness and spoon-shaped nails. Oral signs loss or weight gain, polydypsia, polyphagia, polyuria and in-
and symptoms, including pale oral mucosa, glossitis, angular take of drugs like antibiotics to rule out other systemic causes
cheilitis, and recurrent oral ulcerations offer the dentist an op- of atrophic glossitis. Patient was advised to undergo haema-
portunity to participate in the diagnosis of this condition.4 This tological investigations including complete haemogram with
paper report three cases of atrophic glossitis associated with peripheral smear. Her haemoglobin level was found to be 6.4
iron defieciency anemia. gm%. Peripheral smear showed presence of hypochromic,
|

Case Report 1 microcytic erythrocytes. Final diagnosis of anaemic glossitis


I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

due to microcytic, hypochromic (iron deficiency) anemia was


A 20-year old female reported to the deaprtment of Oral and
formulated. Patient was put on a combination of ferric am-
Maxillofacial Medicine and Radiology with a chief complaint
monium citrate, folic acid and cyanocobalamin. On follow-up
of pain in right back region of toungue for last two weeks with
after one month, patient stated her burning sensation had
difficulty to swallow due to burning sensation. During clinical
completely resolved. On examination of the tongue, the earli-
evaluation, angular chelitis, pale yellow sclera, spoon shaped
er depapillated areas were filled with filiform papillae (Figure
nails of forearm and feet were noticed. The patient also dis-
3) and her haemoglobin was 6.8gm%. The patient was advised
played a intolerance to spicy food and fatigue after simple
periodic follow-up.
daily activities. Oral examination revealed pale oral mucosa,
glossitis with well defined depapillated area on dorsum of Case Report 3
tongue on left side (Figure 1). Hematologic tests were done. A 30 year old female reported to department of oral medicine
Serum iron 27.1 g/dl, serum ferritin 2.44 ng/ml and total iron with a chief complaint of pain in lower right back tooth region
binding capacity to be 453g/dl confirmed diagnosis of iron for last four days. Medical histrory was non-contributory. On
deficiency anemia. Patient was prescribed iron supllement extraoral examination pallor was noticed in the nails and pal-
and reffeered to medical hospital for systemic management. pebral conjunctiva. Multiple fissures were radiating from the
On second followup, the symptoms starts reducing with im- corners of mouth bilaterally. On intraoral examination labial
provement in overall patient wellbeing. mucosa, buccal mucosa and soft palate were pale. Dorsum of
Case Report 2 the tongue showed de-papillated areas with multiple deep
fissures (Figure 4). Provisional diagnosis of iron deficiency ane-
A 20-year old female patient reported to the department of
mia was given. Haematological tests showed 6.2 gm% hae-
oral medicine with a chief complaint of sensitivity to cold and
moglobin and hypochromic and microcytic erythrocytes. Iron
citrus juice in upper front teeth region for last two months.
supplements were prescribed for two months. Followup done
History reveals that she had a habit of taking frequent lem-
after 1 month showed incresae in haemoglobin to be 7.8%
on lozenges. She reported burning sensation on the dorsum
with complete re-papillation of tongue (Figure 5).
of tongue during spicy food intake. The medical history was
non-contributory. Discussion
Tongue diseases could be reflections of altered systemic con-
On intra-oral examination, dental erosion was present in rela-
ditions or, also, initial forms of local and often severe pathol-
tion to 11,21 and 22 involving labial surface. A de-papillated
ogies.1 Iron deficiency is one of the most common disorders
area measuring approximately 1cm in diameter with irregular

30
E-ISSN :0975-8437 P-ISSN: 2231-2285

Atrophic glossitis; an indicator of iron deficiency anemia : Report of three cases

2. Reamy BV, Derby R, Bunt CW. Common tongue conditions in pri-


mary care. Am Fam Physician. 2010;81(5):627-34.
3. Cunha SFdCd, Melo DAd, Braga CBM, Vannucchi H, Cunha DFd.
Papillary atrophy of the tongue and nutritional status of hospital-
ized alcoholics. Anais brasileiros de dermatologia. 2012;87(1):84-
9.
Figure 1. Case 1- Depapillated area on dorsum of tongue, Figure 2. 4. Pontes HAR, Neto NC, Ferreira KB, Fonseca FP, Vallinoto GM, Pon-
Case 2 - Depapillation over dorsum of tongue, Figure 3. Case 2 - Com- tes FSC, et al. Oral manifestations of vitamin B12 deficiency: a
plete papillation post-treatment, Figure 4. Case 3- Depapillation and case report. JCDA. 2009;75(7):533-7.
fissures, Figure 5. Case 3- Complete papillation of tongue on dorsum
of tongue 5. Alleyne M, Horne MK, Miller JL. Individualized treatment for
iron-deficiency anemia in adults. The American journal of medi-
cine. 2008;121(11):943-8.
affecting humans, and iron-deficiency anemia continues to
represent a major public health problem worldwide. It is es-
How cite this article
pecially common among women of childbearing age because Raju V, Arora A, Saddu S. Atrophic glossitis; an indicator of iron defi-
of pregnancy and menstrual blood loss.5 The predisposing fac- ciency anemia : Report of three cases. International Journal of Dental

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
tors of the atrophic glossitis is mainly didvided into local and Clinics. 2014;6(3):30-31.
systemic. Local causes includes trauma to oral mucosa due to
excessive use of tobacco spices, geographic tongue, medi-
an rhomboid glossitis, chronic atrophic candidiasis, fissured
tongue, erosive lichen planus etc. Systemic causes are defi- Address for Correspondence
ciency of Vit B12 or iron or folate leading to anemia, drugs like Dr. Anjana Arora, BDS,
ACE inhibitors, protease inhibitors, antibiotics, aspirin, immu- Post Graduate Student,
no-supressive drug, corticosteroid inhalers, post-menopausal
Department Of Oral Medicine And Radiology,
state in females, diabetes, irritable bowel disease, gastic dis-
turbances leading to hyperacidity, hypothyroidism, loss of The Oxford Dental College,
papillae secondary to epidermolysis bullosa, dyskeratosis con- Bommanahalli, Bangalore,
genita, endocrine candidosis, hyalinosis cutis et mucosae syn- Karnataka,India.
dromes, radiation induced mucositis etc. Dentist can rule out Email: dr.anjanaarora2909@gmail.com
various systemic diseases associated with atrophic glossitis by
the classical clinical signs and symptoms and refer patient to
concerned for management. In cases reported here, atrophic
glossitis was the main clinical manifestation which helped us
in suspecting iron deficiency anemia and which was support-
ed by the results of hemogram and peripheral smear. Confir-
mation of diagnosis of iron deficiency anemia is done by es-
timation of decreased serum iron and ferritin level, increased
serum iron binding capacity and transferrin level. However, for
case 2 and case 3 confirmatory tests were not performed due

|
to economical reasons.

2014 Volume 6 Issue 3


Conclusion
In conclusion, dentist play a crucial role in diagnosing asymp-
tomatic iron deficiency anemia by identifying oral signs and
symptoms like pallor of oral mucosa, atrophic glossitis and
confirming it by performing haematological investigations.
Authrs Affiliations
1. Veena Raju, MDS, Senior Lecturer, Dept. of Oral Medicine and Ra-
diology, The Oxford dental college, Bangalore, India, 2. Anjana Arora,
BDS, Post Graduate Student, Dept. of Oral Medicine and Radiology,
The Oxford dental college, Bangalore, India, 3. Shweta Saddu, BDS,
Post Graduate Student, Dept. of Oral Medicine and Radiology, The
Oxford dental college, Bangalore, India.

References
1. Erriu M, Canargiu F, Orr G, Garau V, Montaldo C. Idiopath- Source of Support: Nil
ic atrophic glossitis as the only clinical sign for celiac disease Conflict of Interest: None Declared
diagnosis: a case report. Journal of medical case reports.
2012;6(1):185.

31

Вам также может понравиться