Tongue necrosis: a rare presentation of temporal arteritis.

An 86-year-old woman presented with dysarthria and a painful tongue that looked dark and swollen and turned pale and offensive a few days later (Figure 1). Though the ESR was only 25 a strong clinical suspicion of giant cell arteritis led to an urgent referral for temporal artery biopsy. She was commenced on steroids whilst awaiting the biopsy, which was definitive. Owing to dysphagia she proceeded to have a percutaneous endoscopic gastrostomy tube inserted. Surgical intervention was avoided due to her general frailty and other comorbidities. Despite the loss of tongue tissue she recovered well and attained near-normal speech and function. Temporal arteritis is the most common cause of tongue necrosis and can masquerade in various forms [1]. High dose of steroids remains the treatment of choice followed by maintenance dose for a couple of years [2]. Benefit of heparin and nitroglycerine infusion is equivocal [3].