By Gary M. White, MD
Median rhomboid glossitis (MRG) is an atrophic lesion in the center of the tongue that appears to be caused by Candida infection. It used to be considered a developmental abnormality, but this idea has been discarded. (Interestingly, a survey of more than 10,000 children was unable to record a single case of MRG [OSOMOP 1971;31;56].) It has been found in higher frequency in patients with diabetes [Iran Red Crescent Med J. 2011 Jul;13(7):503-6].
A rhomboid shaped, atrophic red area in the middle of the tongue is characteristic. It is usually asymptomatic although the patient may note some sensitivity when eating spicy foods. Palatal inflammation above the involved part of the tongue has been noted in HIV-positive patients.
Other manifestations of Candida infection should be sought (e.g., white or red areas elsewhere in the oral mucosa). An oral antifungal agent should be given, e.g., clotrimazole troche. The iron level (e.g. ferritin) should be measured.
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