Pernicious Anemia

Pernicious anemia is associated with atrophic gastritis. The marked loss of gastric parietal cells results in a deficiency of intrinsic factor, which is required to transport Vitamin B12 across the intestinal mucosa. The resulting deficiency of Vitamin B12, which is necessary

FIGURE 43 Pernicious anemia. This elderly female complained of a painful tongue. The mucosa of the anterior portion of the tongue was severely atrophic and totally devoid of lingual papillae. Posteriorly, the mucosa was extensively ulcerated and covered with a fibrinous membrane.

FIGURE 44 Iron deficiency anemia. This adult female complained of a sensitive tongue. Her hemoglobin level was 6.2 g/dL. There is extensive atrophy of the papillae of the dorsal tongue producing a shiny appearance. Source: Courtesy of Charles Dunlap, DDS.

for DNA synthesis, produces a megaloblastic anemia. The papillae of the dorsal tongue undergo atrophy, resulting in a red, smooth surface, which produces symptoms of pain and burning (Fig. 43).

Differential Diagnosis

A similar clinical appearance of the tongue mucosa may be seen in Vitamin B complex deficiencies and iron deficiency anemia (Fig. 44), which are also frequently associated with angular cheilitis. Since both Vitamin B12 and folate deficiencies exhibit macrocytic hyperchromic anemia, it is necessary to perform serum folate and B12 determinations in order to distinguish between them. Atrophic candidiasis (Fig. 45) may also produce a sensitive, erythematous, depapillated lingual mucosal surface.

Treatment, Complications, and Prognosis

The treatment of pernicious anemia involves intramuscular administration of Vitamin B12. The atrophic gastritis associated with pernicious anemia predisposes these patients to gastric carcinoma.

FIGURE 45 Atrophic candidiasis. This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source: Photo courtesy of Bruce Barker, DDS.

FIGURE 45 Atrophic candidiasis. This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source: Photo courtesy of Bruce Barker, DDS.

FIGURE 46 Central papillary atrophy. Also referred to as median rhomboid glossitis, this was long believed to be a developmental condition. It is now recognized as a form of erythematous candidiasis appearing as a well-demarcated zone of erythema in the midline of the dorsal tongue with a smooth or lobulated surface. The lesion is typically asymptomatic and frequently resolves with antifungal therapy.

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