White Hairy Tongue Post-Linezolid Therapy

A man in his 20s presented with a white hairy tongue for a week post-linezolid therapy for small bowel surgery. White, hair-like projections were observed on the dorsum of his tongue, with prominent filiform papillae, sparing the tip and lateral borders [Figure 1a]. KOH mount did not reveal candidiasis. Linezolid was discontinued and the lesion resolved completely [Figure 1b].Figure 1: (a) White, hair-like projections on the dorsum of the tongue, with prominent filiform papillae, sparing the tip and lateral borders. (b) Complete resolution of the white hairy tongue after a week of stopping linezolid therapyHairy tongue is characterized by the elongation of the filiform papillae due to keratin buildup.[1,2] The colour of the coating can vary from cream to brown to black with black being the most commonly observed colour at presentation. Certain medications known to cause black hairy tongue include antibiotics, such as penicillin, tetracyclines, macrolides, linezolid, and metronidazole, as well as antipsychotics, antidepressants, and antineoplastic agents. Black hairy tongue is a rare adverse effect of linezolid therapy. While there are case reports of this phenomenon, white hairy tongue has not been documented yet in the literature. Antibiotics can disrupt the normal bacterial flora, allowing bacteria, such as Porphyromonas gingivalis, and candida to proliferate and cause tongue discoloration. On dermoscopy, black hairy tongue appears as clusters of elongated, filiform, hair-like projections that range from yellow-brown to dark brown-black, resembling “sea anemones,” with scattered white structureless areas on a pink background.[3] Discontinuing the offending medication can help resolve the condition. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) No artificial intelligence was used for the preparation of the manuscript.