舌背部白板症に併発し, 正中菱形舌炎に類似した舌の放線菌症

抄録

Actinomycotic infection appears predominantly in the cervico facial area, but is seldom seen on the tongue.
A very rare case of actinomycosis of the tongue associated with leukoplakia of the dorsum of the tongue, resembling median rhomboid glossitis is herein reported and discussed.
A 63-year-old female patient visited our department complainning of a slight nodular elevation which was devoid of lingual papillae and a painless white patch in the dorsum of the tongue. Clinically, a provisional diagnosis of median rhomboid glossitis and leukoplakia of the tongue was given and primary malignancy was also suspected because of the location of the nodular lesion adjacent to the white patch and the lack of other clinical evidence to support a diagnosis of infection.Using local anesthesia, an incisional biopsy was performed and the specimen was submitted for pathological examination.
Histopathologically, the superficial layer of the epitherium was found to be hyperparakeratotic. The epitherium showed no sign of mitosis.Severe infiltration of inflammatory cells and a cystic space containning granules were noted under the acanthotic epitherium. No findings of malignancy were revealed.
With the diagnosis of median rhomboid glossitis and leukoplakia of the tongue, no special treatment, except for cessation of taking stimulants, was administered.No remarkable changes of the lesion were seen for several months. Upon further study of histopathological findings of the case, actinomycotic granules were noted because of the characteristic peripheral radiating filaments, and numerous fragments of sil-ksutures were also noticed.
Definitive diagnosis of actinomycosis associated with leukoplakia of the tongue was made and the patient was placed on a regimen of oral penicillin, 500 mg.three times a day for 2 weeks.The nodular thickened lesion which was devoid of lingual papillae disappeared and was covered with extended leukoplakia of the tongue.
Recently, the thesis that median rhomboid glossitis is not a developmental anomaly but an infectious disease caused by fungus especially candida albicans has been stressed. From that point of view, our present case may suggest the possible role of actinomycotic infection in the development of median rhomboid glossitis.