Tongue necrosis from temporal arteritis

Abstract

A 77-year-old woman with hypothyroidism presented with a 2-week history of head, neck, jaw, and tongue pain. She had also developed slurred speech and difficulty chewing. On examination she had a temperature of 38.0°C. She was without neurological deficits. However, she did have difficulty protruding her tongue, which had a cyanotic appearance and was painful. Laboratory findings showed an erythrocyte sedimentation rate of 68 mm/hr. Temporal arteritis was suspected, and the patient was started on corticosteroids. A subsequent temporal artery biopsy revealed inflammation and thrombus formation consistent with temporal arteritis. On hospital day 3, she developed unilateral ischemia in her tongue, which eventually became necrotic (Fig.