Spontane Zungennekrose bei rheumatoidem Hyperviskositätssyndrom. Fallbericht und Literaturübersicht

Objectives/Hypothesis Ischemic necrosis of the tongue is a rare entity generally associated with vasculitis. Critically ill patients with shock might experience hypoperfusion of head and neck end organs including the tongue. Study Design Retrospective analysis of hospital charts. Methods Case histories and photographs of five patients who developed ischemic tongue necrosis in the context of cardiogenic shock. Results Five critically ill patients in our institution’s cardiothoracic intensive care unit developed ischemic necrosis of the tongue. All five patients experienced protracted courses of profound cardiogenic shock requiring high-dose vasopressor support and urgent cardiac surgery. Three patients required intraaortic balloon pumps. All patients had concomitant signs of poor end organ perfusion, including lower extremity ischemia and renal and hepatic failure. Ultimately, four of five patients died, with one patient surviving after sloughing of the entire oral tongue. Conclusions Ischemic necrosis of the oral tongue is an uncommon but perhaps under-reported manifestation of end organ hypoperfusion in shock, likely signifying poor prognosis.

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Ischemic necrosis of the tongue in patients with cardiogenic shock

Roman

Immerman

Morris

2010

The Laryngoscope

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Tongue necrosis as an unusual presentation of carotid artery stenosis

Bjordahl

Ammar

2011

Journal of Vascular Surgery

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A 57-year-old man with premature coronary artery disease presented to the emergency department with left facial pain, numbness, and tongue swelling. The patient was found to have significant tongue necrosis, and subsequent arteriography demonstrated carotid bifurcation stenosis with embolization to the left lingual artery. The patient was successfully treated with debridement of his tongue and left carotid endarterectomy.

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Syndrome d’hyperviscosité plasmatique

Dumas

Merceron

Zafrani

et al. 2015

La Revue de Médecine Interne

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Hyperviscosity syndrome is a life-threatening complication. Clinical manifestations include neurological impairment, visual disturbance and bleeding. Measurement of plasma or serum viscosity by a viscometer assesses the diagnosis. Funduscopic examination is a key exam because abnormalities are well-correlated with abnormal plasma viscosity. Etiologies are various but symptomatic hyperviscosity is more common in Waldenström's macroglobulinemia and multiple myeloma. Prompt treatment is needed: treatment of the underlying disease should be considered, but generally not sufficient. Symptomatic measures aim to not exacerbate blood viscosity while urgent plasmapheresis effectively reduces the paraprotein concentration and relieves symptoms.

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Spontane Zungennekrose bei rheumatoidem Hyperviskositätssyndrom. Fallbericht und Literaturübersicht

Abstract: Apart from the presentation of the first reported case of lingual necrosis in rheumatoid hyperviscosity syndrome, the intention of this article is to draw the clinician's attention on the fundamental aspects of lingual ischaemia and of temporal arteritis.

Cited by 7 publications

References 23 publications

Ischemic necrosis of the tongue in patients with cardiogenic shock

Ischemic necrosis of the tongue in patients with cardiogenic shock

Tongue necrosis as an unusual presentation of carotid artery stenosis

Syndrome d’hyperviscosité plasmatique

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