The Washington Post featured one of two Washington University ID cases appearing in The New England Journal of Medicine last week in its Images in Clinical Medicine section.
Black Hairy Tongue. Hamad Y, Warren DK. N Engl J Med. 2018 Sep 6;379(10):e16. doi: 10.1056/NEJMicm1800351.
“Black Hairy Tongue” was submitted by Yasir Hamad, M.D., assistant professor of medicine and David K. Warren, M.D, MPH, professor of medicine. Black hairy tongue is a relatively rare medical condition. Dr. Hamad indicated this is the first case he has seen since he has been practicing in the US over the last 10 years.
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, symptoms appeared within one week of initiating minocycline for a wound infection. Mincocycline was discontinued, and an alternate antimicrobial regimen was started. Within 4 weeks after the minocycline was stopped, her tongue returned to its normal color
Glandular Tularemia. Laura Marks, M.D., Ph.D., and Andrej Spec, M.D. N Engl J Med. 2018 Sep 6;379(10):967. DOI: 10.1056/NEJMicm1801531
The second case featured was a diagnosis of Glandular Tularemia submitted by Washington University fellow, Laura Marks, MD, PhD and faculty member, Andrej Spec, MD. A 68-year-old man from Missouri presented to the primary care clinic with a history of 1 week of fever followed by 2 months of progressive, painful swelling on the right side of his neck.Two days prior, his cat died. Serologic testing with IgM antibody was positive for Francisella tularensis (titer, 1:1280). A diagnosis of glandular tularemia was made. Glandular tularemia is the second most common manifestation of tularemia after the ulceroglandular form. Because culture requires biosafety level 3 conditions, diagnosis is often confirmed serologically. Domestic cats can become infected through the consumption of infected prey and can transmit the bacteria to humans. The patient was treated with doxycycline for 4 weeks; the lesions improved within 5 days and resolved within 3 weeks.