Images in Clinical Medicine
Lingual Raynaud's Phenomenon
N Engl J Med 2012; 366:e12February 16, 2012
- Article
A 20-year-old woman presented with a report of tongue numbness. The patient had a long-standing history of Raynaud's phenomenon and had received a diagnosis of mixed connective-tissue disease; testing was positive for antinuclear and anti-ribonucleoprotein antibodies. She was receiving prostacyclin for Raynaud's phenomenon. Two years before presentation, she had begun having intermittent attacks of tongue numbness with concomitant dysarthria. These attacks did not seem to coincide with digital vasospasm and usually resolved within 15 minutes. Because the attacks never occurred during a medical visit, she used her mobile-phone camera to take a picture of her tongue during an attack. The photo showed a prominent white tongue consistent with lingual Raynaud's phenomenon. Raynaud's phenomenon affecting the tongue can occur in patients with or without autoimmune diseases such as scleroderma. Photographs taken by patients during attacks can be useful for the identification of such transient color changes. The patient continues to have intermittent Raynaud's phenomenon but is otherwise well, with daily administration of 2.5 mg of prednisolone, prostacyclin, and a proton-pump inhibitor.
Yoshinori Katada, M.D., Ph.D.
National Hospital Organization Osaka-Minami Medical Center, Kawachinagano City, Japan
kataday@omh.hosp. go. jp Toshio Tanaka, M.D., Ph.D.
Osaka University Graduate School of Medicine, Suita City, Japan
