Black Hairy Tongue
A 55-year-old woman was admitted to the hospital after sustaining a severe crush injury to both legs in a motor vehicle accident. A polymicrobial wound infection developed, and she received treatment with intravenous meropenem and oral minocycline. Black discoloration of her tongue was observed within 1 week after treatment was started (Panel A), and the patient reported nausea and a bad taste in her mouth. Black hairy tongue, resulting from treatment with minocycline, was suspected. Black hairy tongue is a benign condition characterized by hypertrophy and elongation of filiform papillae on the surface of the tongue, with brownish-black discoloration. The condition can be associated with multiple factors, including poor oral hygiene, the use of tobacco or irritating mouthwashes, and the receipt of antibiotic agents, particularly tetracyclines. Black hairy tongue is usually reversible and has no long-term sequelae as long as the precipitating agent is discontinued and the patient practices good oral hygiene. In this patient, minocycline was discontinued, and an alternate antimicrobial regimen was started. She was advised to practice good oral hygiene. Within 4 weeks after the minocycline was stopped, her tongue returned to its normal color (Panel B).
