Tongue involvement revealing sarcoidosis

Sir, Sarcoidosis is an immune-mediated condition affecting multiple organs, especially the lungs, lymph nodes, skin and eyes.1–4 Oral involvement, including tongue manifestations, is considered to be a rare complication of sarcoidosis; in fact, to the best of our knowledge, there have been only five cases of patients exhibiting sardoidosis-associated tongue impairment, reported in the English literature.5–8 We recently observed the interesting case of a patient who developed tongue involvement as the first manifestation of sarcoidosis. A 25-year-old woman, with unremarkable previous medical history, presented with a painless ulceration of 5-month duration, involving her tongue. The patient also complained of both fatigue and a 3 kg weight loss, and night sweats. At admission, oral examination demonstrated an ulcerated lesion with a central yellowish base, involving the inferior part of her tongue (Figure 1); general physical examination was otherwise normal. Laboratory findings disclosed the following: erythrocyte sedimentation rate (ESR): 10 mm/h, C-reactive protein: 14 mg/l, haemoglobin: 13.4 g/dl, white blood cell count: 5.1 × 109/l, platelet count: 225 × 109/l. Other routine biochemical tests, including glycaemia, renal and liver tests, vitamin B12 and folic acid blood levels, as well as blood and urinary protein immunoelectrophoresis, were normal. Blood cultures, urinalysis, as well as bacterial ( Treponema pallidum, Mycoplasma pneumoniae, …