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A 24-year-old man presents to a hospital in Tampa, Florida with a black tongue covered in “hair”. No doubt for doctors, it is a lingua villosa nigra, a tongue condition that stains the taste buds black filiform – which are not involved in the perception of taste but fulfill a mechanical role. The origin of this rare infection remains to be understood.
The patient appears healthy, he does not smoke, and his black tongue is not accompanied by other symptoms as feveror some swollen glands. He tells the doctors that he is taking ciprofloxacin and doxycycline. The puzzle pieces are starting to fit together.
An opportunistic yeast infection
A levy on language of the patient makes it possible to identify the person responsible for this black carpet: Candida albicansa yeast commensal which is offensive in the majority of cases, but which can become pathogenic when conditions are favorable. Here is the treatment antibiotic of the young man, especially doxycycline, which allowed the proliferation of microorganism.
Several cases of lingua villosa nigra are described in the scientific literature with commonalities: patients develop the disease while they are on antibiotic or herbal treatment bismuth to treat a separate medical condition – in this case, an upper respiratory infection. The excessive consumption of tobacco may promote this impressive condition, although cases in non-smokers have also been reported. Whether Candida albicans is the cause of most infections, other so-called chromogenic microorganisms may be responsible for the characteristic black and hairy appearance of the tongue.
If it is impressive, the lingua villosa nigra is a benign illness that resolves in a few days with adequate treatment. Here, the patient stopped taking doxycycline and the doctors prescribed him a brief course of fluconazole, an antifungal indicated in the treatment of candidiasis. Our patient saw his tongue regain a normal appearance after three days.
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