Uremic Stomatitis
A 26-year-old man presented to the emergency department with a 2-month history of an altered sense of taste and painless sloughing of the tongue associated with malaise, weight loss, and muscle cramps. He had a history of chronic kidney disease attributed to vesicoureteral reflux. Initiation of dialysis and evaluation for renal transplantation had been recommended 3 years earlier, but he had been lost to follow-up. The physical examination showed white, sharply demarcated, adherent plaques on the sides (Panel A) and undersurface (Panel B) of the tongue. Laboratory tests showed a creatinine level of 22 mg per deciliter (reference range, 0.7 to 1.5) and a blood urea nitrogen level of more than 225 mg per deciliter (reference range, 9 to 20). These findings were consistent with uremic stomatitis, and hemodialysis was initiated. Uremic stomatitis is a rare manifestation of long-standing uremia. Resolution of the tongue lesions was seen after three hemodialysis sessions (Panels C and D). The patient continues to receive hemodialysis and is undergoing evaluation for renal transplantation.