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LETTER TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 2  |  Page : 189-190

Linezolid-induced black pigmentation of tongue and perioral region


Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India

Date of Web Publication29-Mar-2019

Correspondence Address:
Prof. Angoori Gnaneshwar Rao
Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_24_18

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How to cite this article:
Rao AG, Aparna K, Reddy VS, Farheen SS, Hakkani R, Parimala D, Tejal M, Gupta S. Linezolid-induced black pigmentation of tongue and perioral region. Indian J Paediatr Dermatol 2019;20:189-90

How to cite this URL:
Rao AG, Aparna K, Reddy VS, Farheen SS, Hakkani R, Parimala D, Tejal M, Gupta S. Linezolid-induced black pigmentation of tongue and perioral region. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Dec 7];20:189-90. Available from: http://www.ijpd.in/text.asp?2019/20/2/189/255197



Sir,

A 7-year-old boy was referred from the orthopedic department for blackish discoloration of the tongue of 1-week duration. He was under treatment with linezolid for septic arthritis for the past 2 weeks. Boy's father noticed blackish discoloration of the tongue following a week's treatment with linezolid. Parents denied a history of giving any other medication except linezolid. Cutaneous examination revealed diffuse pigmentation of the perioral region. Oral examination revealed diffuse black pigmentation involving dorsum of the tongue sparing margins [Figure 1]. Teeth, gums, palate, and buccal mucosa were unremarkable. Nail and hair were normal. Complete blood picture, serum B12, serum cortisol, and serum electrolytes were normal. Scraping was negative for fungal filaments from the pigmented area of the tongue. Culture for bacteria and candida was negative. Serology for human immunodeficiency virus and venereal disease research laboratory test was nonreactive. Clearance of black pigmentation of the tongue and perioral region was observed 2 weeks after stoppage of linezolid [Figure 2]. Pigmentation of tongue and perioral region following intake of linezolid and its disappearance on stoppage validate causal relation in the index case. Furthermore, the Naranjo probability scale revealed a possible adverse drug reaction of linezolid-induced black pigmentation tongue.
Figure 1: Diffuse perioral pigmentation and black pigmentation on the dorsum of tongue sparing margins

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Figure 2: Clearance of pigmentation of the tongue and perioral region following withdrawal of linezolid

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Linezolid is the first Oxazolidinone with broad-spectrum antibacterial activity particularly effective and safe against methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Therapy with linezolid for more than 4 weeks may cause reversible bone marrow suppression and neuropathy. Black hairy tongue (BHT) is due to pigmentation and hypertrophy of the filiform papillae. The reported incidence of BHT in patients receiving linezolid was 0.2% in a study by Hau.[1] Linezolid-induced black discoloration of the tongue is the most common discoloration encountered; however, yellow, orange, brown, and green discoloration has also been reported.[2] It is due to defective desquamation of dorsum of the tongue, usually involving posterior one-third.[3] Blackish discoloration of the tongue has also been described with medications such as cephalosporins, penicillin, sulfonamides, methyldopa, steroids, and lansoprazole.[4] Predisposing factors for the discoloration include smoking or chewing of tobacco, poor oral hygiene, and xerostomia. Linezolid-induced black pigmentation of the tongue and perioral pigmentation in the index case in the absence of predisposing factors is notable and literature search failed to reveal a report on linezolid-induced black pigmentation of the tongue along with perioral pigmentation. Petropoulou et al. reported discoloration of teeth along with BHT in three children induced by linezolid.[5] Nonetheless, teeth were unaffected in the index case. The median time gap between linezolid intake and BHT reported in the literature is 2 weeks. However, time gap was shorter (7 days) between linezolid intake and pigmentation of the tongue in the index case. Management of the condition consists of discontinuation of the offending drug and maintenance of good oral and dental health.[6] If it persists, gentle cleaning of the tongue with soft toothbrush and baking soda or 3% hydrogen peroxide may be tried.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hau T. Efficacy and safety of linezolid in the treatment of skin and soft tissue infections. Eur J Clin Microbiol Infect Dis 2002;21:491-8.  Back to cited text no. 1
    
2.
Thompson DF, Kessler TL. Drug-induced black hairy tongue. Pharmacotherapy 2010;30:585-93.  Back to cited text no. 2
    
3.
Manabe M, Lim HW, Winzer M, Loomis CA. Architectural organization of filiform papillae in normal and black hairy tongue epithelium: Dissection of differentiation pathways in a complex human epithelium according to their patterns of keratin expression. Arch Dermatol 1999;135:177-81.  Back to cited text no. 3
    
4.
Jover-Diaz F, Cuadrado-Pastor JM, Talents-Bolos A, Martin-Gonzalez C. Black tongue associated with linezolid. Am J Ther 2010;17:e115-7.  Back to cited text no. 4
    
5.
Petropoulou T, Lagona E, Syriopoulou V, Michos A. Teeth and tongue discoloration after linezolid treatment in children. Pediatr Infect Dis J 2013;32:1284-5.  Back to cited text no. 5
    
6.
Sarti GM, Haddy RI, Schaffer D, Kihm J. Black hairy tongue. Am Fam Physician 1990;41:1751-5.  Back to cited text no. 6
    


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