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      Long-term use of triple antibiotic-induced black hairy tongue: A case report

      case-report

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          Abstract

          Black hairy tongue is a rare condition, characterized by a black discoloration and hair-like structure appearing on the dorsal surface of the tongue. The mechanism of black hairy tongue remains unclear but could be predisposed by multiple factors. We described a case of a 53-year-old Chinese female with a diagnosis of bronchiectasis complicated with Mycobacterium abscessus infection, and a triple antibiotic regimen was prescribed for the infection. One month later, a black hairy tongue appeared. The clinical pharmacist was consulted to investigate the association of medication-related factors by the attending clinician, and the clinical pharmacist identified the potential cause and suggested an appropriate treatment for the black hairy tongue. The black hairy tongue disappeared and did not recur during subsequent treatment.

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          Most cited references31

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          Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units.

          Mark E Mlynarek, Suzan Kucukarslan, Michael Peters … (2003)
          Previous studies found that medication errors result from lack of sufficient information during the prescribing step. Therefore, it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events (ADEs). The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process. A single-blind, standard care-controlled study design was used to compare patients receiving care from a rounding team including a pharmacist with patients receiving standard care (no pharmacist on rounding team). Patients admitted to and discharged from the same general medicine unit were included in the study. The main outcome measure of this study was preventable ADEs. Patient records were randomly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician. Interventions made by the pharmacists in the treatment group were documented. The rate of preventable ADEs was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. The most common interventions were (1) dosing-related changes and (2) recommendations to add a drug to therapy. Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs.
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            Black hairy tongue syndrome.

            Grigoriy Gurvits, Amy CW Tan (2014)
            Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient's re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.
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              Diseases of the tongue.

              Roy S Rogers, Rochelle R Torgerson, Aaron Mangold (2016)
              The tongue is a complex organ involved in speech and expression as well as in gustation, mastication, and deglutition. The oral cavity, along with the tongue, are sites of neoplasms, reactive processes, and infections, and may be a harbinger of systemic diseases. This review includes both common and rare diseases that occur on the tongue, including: vascular and lymphatic lesions (infantile hemangiomas and oral varices), reactive and inflammatory processes (hairy tongue, pigmented fungiform papillae of the tongue, benign migratory glossitis, and fissured tongue), infections (oral hairy leukoplakia, herpes simplex and varicella-zoster virus infections, human papillomavirus, and candidiasis), premalignant lesions (leukoplakia and erythroplakia), malignant lesions (squamous cell carcinoma, Kaposi sarcoma, and lymphoproliferative diseases), and signs of systemic disease (nutritional deficiency and systemic amyloidosis).
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                Author and article information

                Journal
                Journal ID (nlm-ta): SAGE Open Med Case Rep
                Journal ID (iso-abbrev): SAGE Open Med Case Rep
                Journal ID (publisher-id): SCO
                Journal ID (hwp): spsco
                Title: SAGE Open Medical Case Reports
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 2050-313X
                Publication date (Electronic): 3 October 2023
                Publication date Collection: 2023
                Volume: 11
                Electronic Location Identifier: 2050313X231204136
                Affiliations
                [1 ]Pharmacy Department, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
                [2 ]College of Pharmacy, Jinan University, Guangzhou, China
                Author notes
                [*]Zhi-Cheng Yang, Pharmacy Department, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen 518053, China. Email: yangzc@ 123456hku-szh.org
                Author information
                https://orcid.org/0009-0002-3540-8009
                https://orcid.org/0000-0001-5202-8433
                Article
                Publisher ID: 10.1177_2050313X231204136
                DOI: 10.1177/2050313X231204136
                PMC ID: 10548800
                SO-VID: b97e13c4-f085-4df4-837c-89901c2c3ee7
                Copyright © © The Author(s) 2023
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 13 May 2023
                Date accepted : 11 September 2023
                Categories
                Subject: Case Report
                Custom metadata
                cover-date January-December 2023
                typesetter ts1

                Keywords: hairy tongue,mycobacterium abscessus infection,triple antibiotic use,clinical pharmacist
                Data availability:
                Keywords: hairy tongue, mycobacterium abscessus infection, triple antibiotic use, clinical pharmacist

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