Case reportGlossitis with linear lesions: An early sign of vitamin B12 deficiency
Introduction
The classic triad of vitamin B12 deficiency consists of the presence of megaloblastic anemia, gastrointestinal symptoms or glossitis, and neuropsychiatric symptoms.1 Early diagnosis is important because neurologic signs could be irreversible.
Vitamin B12 deficiency can present with several oral manifestations, which are considered nonspecific. Hunter's glossitis (or Moeller-Hunter) is the most classic form. Hunter's glossitis, which presents in up to 25% of cases,2 is characterized by diffuse erythema and lingual atrophy. There are other oral manifestations of vitamin B12 deficiency: glossodynia, recurrent ulcers, lingual paresthesia, burning, pruritus, dysgeusia, intolerance to dental prosthesis, intermittent xerostomia, stomatitis, and cheilitis.3, 4, 5, 6, 7, 8, 9, 10 All manifestations are considered clinically nonspecific. The majority of published cases are in the odontologic literature.
We describe 4 patients with oral linear lesions associated with vitamin B12 deficiency. We suggest that this presentation is evocative of the deficit and precedes the onset of macrocytic anemia.
Section snippets
Cases
The major clinical and laboratory findings are summarized in Table I.
Patient 1 was referred in May 2003 because of stomatitis and glossitis of 1 year's duration. She had been treated for malignant melanoma in the gluteal region in 1988, without further problems. In 1995 a hysterectomy with removal of the ovaries and Fallopian tubes was performed because of squamous cell carcinoma of the cervix; as sequelae of the procedure, a ureterorectal fistula and bowel subocclusive episodes resulted. On
Discussion
Glossitis in vitamin B12 deficiency is present in up to 25% of cases2; it is traditionally described as a diffuse and clinically nonspecific atrophy of lingual papillae affecting more than half of the tongue, and it is classically known as Hunter's glossitis or glossitis of Moeller-Hunter.
The glossitis found in our patients does not correspond to the classic description. All of our cases presented with linear lesions. We think that our patients, if not diagnosed, would have developed the
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Cutaneous signs of nutritional disorders
2021, International Journal of Women's DermatologyCitation Excerpt :The broader term “atrophic glossitis”, which describes a smooth beefy-red tongue, can be a manifestation of other nutritional deficiencies (folate, iron, niacin, riboflavin, and zinc), as well as candidiasis, Helicobacter pylori infection, xerostomia, and diabetes mellitus (Chiang et al., 2020). Atrophic linear lesions on the tongue and hard palate may be a more specific early clinical sign of vitamin B12 deficiency that precedes the onset of macrocytic anemia (Graells et al., 2009). Symptoms of glossitis include a generalized sore mouth, burning, and taste disturbance (Brescoll and Daveluy, 2015).
Vitamin deficiencies/hypervitaminosis and the skin
2021, Clinics in DermatologyCitation Excerpt :Vitamin B12 deficiency can be diagnosed by measuring serum cobalamin levels.95 If the serum value is less than 148 pmol/L (200 ng/L), deficiency is technically considered.93 For oral treatment, cyanocobalamin can be given at a dose of 50 to 150 μg daily.
Oral manifestations of nutritional disorders
2017, Clinics in DermatologyCitation Excerpt :Strict vegetarians, patients with stomach or intestinal resections, elderly patients, and patients with CD are at risk for cobalamin deficiency. Recurrent aphthous stomatitis may manifest in 18% to 28% of patients with B12, folic acid, and iron deficiencies.7,69,74–77 Other oral manifestations in cobalamin deficiency include a prodrome of burning and soreness of the tongue, with fissuring and possible loss of circumvallate papillae leading to eventual diminished taste sensation (Figure 5).15
Hunter’s glossitis and autoimmune gastritis: a case report
2024, QJM: An International Journal of MedicineB12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I
2024, Journal of Oral Pathology and Medicine
Funding sources: None.
Conflicts of interest: None declared.
This work was presented as a poster at the XXXVI Spanish National Congress of Dermatology and Venereology, Barcelona, June 11-14, 2008; it received second place award to the best poster of the Congress.