Lingua villosa nigra in a patient with a Zenker's diverticulum

Abstract

Lingua villosa nigra (LVN), also called black hairy tongue, is a common benign condition with many known predisposing factors. When LVN shows no or modest improvement after conservative treatment, additional examinations should be performed to identify the underlying cause. Here we report a case in which therapy-resistant (LVN) was found to be related to a Zenker's diverticulum associated with gastro-esophageal reflux disease (GERD). A 75-year-old woman presented with black discoloration of the tongue and halitosis, which had been present for years. Examination of the gastrointestinal tract revealed a Zenker's diverticulum (ZD) in association with GERD. The resulting acidic oral mucosa, combined with regurgitation of food from the diverticulum, led to the LVN. After diverticulum treatment by a cricopharyngeal myotomy, the patient's symptoms disappeared and there was no recurrence.In a patient with a Zenker's diverticulum, the combination of food regurgitation and an acidic oral mucosa can lead to lingua villosa nigra. The presently described case highlights the need for a thorough examination of the patient's underlying conditions when conservative interventions for LVN are ineffective.

Keywords

• Lingua villosa nigra
• Black hairy tongue
• Zenker's diverticulum
• GERD