Oral cavity & oropharynx
Inflammatory / immune mediated (noninfectious)
Transient lingual papillitis
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PubMed Search: Transient lingual papillitis
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Negative stains | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Goldfaden JS, Vargo RJ. Transient lingual papillitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavitytransientlingualpapillitis.html. Accessed December 26th, 2024.
Definition / general
- Common inflammatory condition of the fungiform papillae of the anterior dorsal tongue with various speculated etiologies
- Transient lingual papillitis is self limiting and usually does not require treatment
Essential features
- Involves 1 to several fungiform papillae of the anterior dorsal tongue, which become hypertrophic, erythematous and occasionally keratotic or ulcerated
- Transient lingual papillitis affects individuals of a broad age range with a female predilection (J Clin Exp Dent 2017;9:e157)
- Exact cause of transient lingual papillitis is unknown, though there is speculation it may be caused by a variety of agents, including local irritation, stress, gastrointestinal disturbance, hormone fluctuation, upper respiratory tract infections, viral infections, sensitivities to food, beverages and oral hygiene products, alcohol consumption, smoking and hot food intake (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187)
- Histologically, the affected fungiform papillae may exhibit ragged keratosis of the surface epithelium, vascular proliferation within the stroma accompanied by acute and chronic inflammation, as well as foci of ulceration or transmigratory neutrophils
Terminology
- In 1989, Galun and Rubinow reported a case of photocopier papillitis in a 35 year old chief medical resident who noticed severe burning of the tip of his tongue associated with superficial ulceration and papillitis; the resident reported touching his tongue repeatedly when paging through scanned documents and concluded he developed these symptoms from exposure to toner (Lancet 1989;2:929)
- Transient lingual papillitis is a term that was coined by Whitaker et al. in 1996 to describe a relatively common phenomenon in which individuals experience evanescent, inflammatory hyperplasia of fungiform papillae of the dorsal tongue (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
- Additionally, in a 1996 case series by Silverberg et al., a similar occurrence was described as lingual fungiform papillae hypertrophy, which was observed in association with cyclosporine A use (Lancet 1996;348:967)
- 2004 case series by Roux et al. reported an acute, idiopathic stomatitis with inflammatory hypertrophy of the fungiform papillae affecting children with potential spread to family members; this observation was referred to as eruptive lingual papillitis with household transmission (Br J Dermatol 2004;150:299)
- Roux et al. stated in the conclusion of their case series that this phenomenon resembles the entity known as transient lingual papillitis or lie bumps (Br J Dermatol 2004;150:299)
- In 2005, Marks et al. introduced the term fungiform papillary glossitis to describe inflammation of the fungiform papillae of the tongue in response to heat and certain foods (Br J Dermatol 2005;153:740)
ICD coding
Epidemiology
- Transient lingual papillitis can affect individuals of any age, with an average age of ~32 years old; there is a female predilection for this condition (J Clin Exp Dent 2017;9:e157)
Sites
- Transient lingual papillitis involves 1 to several fungiform papillae of the anterior dorsal tongue (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
Pathophysiology
- Irritant affects fungiform papillae on the anterior dorsal tongue, which subsequently becomes edematous and inflamed; these hypertrophic papillae may become ulcerated or keratotic secondary to mechanical or chemical trauma
Etiology
- Etiology of transient lingual papillitis is currently unknown; however, a variety of causative factors have been considered, including local irritation, stress, gastrointestinal disturbance, hormone fluctuation, upper respiratory tract infections, viral infections and sensitivities to food, beverages and oral hygiene products (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187)
- Smoking, alcohol consumption, mechanical friction and hot foods have also been suspected to elicit transient lingual papillitis (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187)
Clinical features
- Typically, 1 to several fungiform papillae of the anterior dorsal tongue are involved and appear as enlarged, elevated, red papules; papules may sometimes appear yellow due to ulceration or white due to keratosis
- Transient lingual papillitis is often associated with mild to moderate pain, though patients are asymptomatic in some cases (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187, Ann Dermatol 2014;26:415)
- Lingual papillitis usually resolves after a few hours or 1 - 4 days but can last for 1 - 3 weeks if diffuse lingual inflammation is present (J Clin Exp Dent 2017;9:e157)
- Individuals may also experience altered taste (Oral Surg Oral Med Oral Pathol Oral Radiol 2020;129:e118)
- Transient lingual papillitis is often associated with mild to moderate pain, though patients are asymptomatic in some cases (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187, Ann Dermatol 2014;26:415)
Diagnosis
- Patients may present with painful enlargement of the fungiform papillae of the dorsal tongue
- Alternatively, this condition may be found incidentally if asymptomatic
Case reports
- 6 year old girl with sudden onset of erythematous papules all over her tongue (Dermatol Reports 2021;13:9020)
- 8 year old boy with acute burning sensation of his tongue and a salty taste perception after eating cucumber (Oral Surg Oral Med Oral Pathol Oral Radiol 2020;129:e118)
- 27 year old woman with painful red and white papules of her dorsal tongue after consuming Atomic FireBall® hard candy (Dermatol Online J 2016;22:13030)
Treatment
- Usually resolves after a few hours or 1 - 4 days but can last for 1 - 3 weeks if diffuse lingual inflammation is present (J Clin Exp Dent 2017;9:e157)
- Variable responses to over the counter products, including Listerine and witch hazel, salt water rinses and topical steroid preparations; there are some reports of relief with improved diet (consumption of yogurt, fruits and vegetables) or cold fluid intake (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
- Acetaminophen and ibuprofen have been reported to have no effects on the duration or intensity of symptoms (Br J Dermatol 2004;150:299)
Clinical images
Contributed by Richard J. Vargo, D.M.D., M.B.A.
Hypertrophic, keratotic lingual papillae
Solitary, hypertrophic fungiform papilla
Microscopic (histologic) description
- Proliferation of small blood vessels within the lamina propria
- Mixed acute and chronic inflammation of the stroma
- Chronic lymphocytic infiltrate may be observed superficially in the connective tissue that occasionally extends into the basal cell layer of the overlying epithelium (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
- Foci of ulceration or neutrophils transmigrating the epithelium may be noted (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
- Ragged surface keratosis with bacterial colonization can also be seen (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:187)
Microscopic (histologic) images
Contributed by Joshua Seth Goldfaden, D.D.S.
Inflamed fungiform papilla
Vascular proliferation of stroma
Ragged surface keratosis
Surface bacterial colonization
Lymphocytes infiltrating basal layer
Hypertrophic fungiform papillae
Negative stains
- HPV (types 6 and 11) and HSV (types I and II) immunohistochemical stains; PAS and Giemsa special stains (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:441)
Sample pathology report
- Anterior dorsal tongue, left, excisional biopsy:
- Lingual papillitis (see comment)
- Comment: Microscopic examination reveals a tastebud rich nodular structure with neural tissue rich subepithelial connective tissue consistent with a hyperplastic fungiform papilla. Chronic inflammation of the underlying connective tissue is also present, consistent with lingual papillitis. Correlate with clinical and patient history.
Differential diagnosis
- Scarlet fever (strawberry tongue):
- Marked, rather than localized, inflammation of the tongue and its papillae
- Inflammation is both acute and chronic
- Filiform papillae are typically atrophic, creating the impression that the fungiform papillae are hypertrophic
- Reddened appearance of the tongue is attributable to both atrophy of the filiform papillae and hyperemia / vascular congestion
- Herpetiform aphthous ulcers:
- Fibrin comprises ulcer bed with transmigratory neutrophils, which may be a result of secondary bacterial infection
- Endothelial proliferation deep to ulcer bed may be seen as a part of the remodeling process
- Ragged keratosis along the periphery of the ulcer bed is usually not present unless the ulcer is traumatized
- Pyogenic granuloma:
- Proliferation of granulation tissue with prominent vasculature
- Capillary vessels may be organized in a lobular fashion and proliferating endothelial cells are delineated by fibrous septations (i.e., lobular capillary hemangioma)
- Proliferation of granulation tissue with prominent vasculature
- Hand, foot and mouth disease:
- Intraepithelial vesicles are seen with ballooning degeneration of the epithelial cells (cytopathic effect of coxsackievirus)
- Epithelium may show necrosis, particularly at the site of vesicular formation that leads to tissue sloughing and subsequent ulceration
- Predominantly lymphocytic infiltrate, which is suggestive of viral infection, though transmigratory neutrophils may also be present in response to superimposed bacterial infection
- Intraepithelial vesicles are seen with ballooning degeneration of the epithelial cells (cytopathic effect of coxsackievirus)
- Herpetic stomatitis:
- Intraepidermal blisters precede ulcers, which often coalesce
- Involved keratinocytes immediately adjacent to ulcer exhibit cytopathic effect, including margination of chromatin, multinucleation and nuclear molding
- Recurrent lesions are typically unilateral and arise from affected dermatome
Board review style question #1
A 28 year old woman presents with a chief complaint of burning of her dorsal tongue, which exhibits elevated, erythematous, 0.5 cm, fungiform papillae following consumption of a cinnamon hard candy. Provided this history in conjunction with the photomicrograph, what is the most appropriate diagnosis?
- Hand, foot and mouth disease
- Herpetic stomatitis
- Pyogenic granuloma
- Transient lingual papillitis
Board review style answer #1
D. Transient lingual papillitis. Transient lingual papillitis has numerous suspected etiologies, including certain foods; additionally, the photomicrograph exhibits a hypertrophic lingual papilla with somewhat ragged surface keratosis, stromal vascular proliferation and chronic inflammation. Answer A is incorrect because hand, foot and mouth disease of the tongue exhibits ballooning degeneration of the squamous epithelium with intraepithelial blistering, necrosis and sloughing. Answer B is incorrect because herpetic stomatitis exhibits ulceration and cytopathic effect of immediately adjacent keratinocytes, including multinucleation and nuclear molding. Answer C is incorrect because pyogenic granulomas exhibit a proliferation of highly vascular granulation tissue within the stroma. Additionally, the size of the lesion provided in the clinical history (0.5 cm) is quite small for a pyogenic granuloma.
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Reference: Transient lingual papillitis
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Board review style question #2
A 9 year old girl presents with mild pain in her dorsal tongue and inflamed, 0.5 cm, hypertrophic fungiform papillae after eating cucumbers. A biopsy of one of the papillae was taken and revealed ragged surface keratosis, focal ulceration and stromal vascular proliferation with accompanying acute and chronic inflammation. Based on this information, what is the best diagnosis?
- Hand, foot and mouth disease
- Herpetic stomatitis
- Pyogenic granuloma
- Transient lingual papillitis
Board review style answer #2
D. Transient lingual papillitis. Transient lingual papillitis has numerous suspected etiologies, including certain foods; additionally, the histopathologic description of ragged surface keratosis, focal ulceration, stromal vascular proliferation and accompanying acute and chronic inflammation are consistent with transient lingual papillitis. Answer A is incorrect because hand, foot and mouth disease of the tongue exhibits ballooning degeneration of the squamous epithelium with intraepithelial blistering, necrosis and sloughing. Answer B is incorrect because herpetic stomatitis exhibits ulceration and cytopathic effect of immediately adjacent keratinocytes, including multinucleation and nuclear molding. Answer C is incorrect because pyogenic granulomas exhibit a proliferation of highly vascular granulation tissue within the stroma. Additionally, the size of the lesion provided in the clinical history (0.5 cm) is quite small for a pyogenic granuloma.
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