Strawberry Tongue: A Clinical Sign Not to Be Overlooked

Strawberry tongue is a distinctive clinical sign that can be observed in various medical conditions, particularly in children. This term describes a specific appearance of the tongue, where the filiform papillae are shed, revealing hypertrophied fungiform papillae, which resemble the seeds of a strawberry. This phenomenon is often the result of a systemic inflammatory process.

Characteristics of Strawberry Tongue

Strawberry tongue is characterized by:

• Shedding of Filiform Papillae: The filiform papillae, which normally cover the tongue's surface, are lost due to inflammation.
• Hypertrophy of Fungiform Papillae: The fungiform papillae, normally less visible, become prominent and resemble the seeds of a strawberry.
• Erythema: The tongue may appear red and inflamed, adding to the distinctive look of this clinical sign.

Causes of Strawberry Tongue

Strawberry tongue is not specific to a single disease and can be seen in several conditions:

Kawasaki Disease

This syndrome, which primarily affects young children, is a systemic vasculitis that can lead to inflammation of the blood vessels. Strawberry tongue is one of the common clinical signs of Kawasaki disease.

Multisystem Inflammatory Syndrome in Children (MIS-C)

Associated with SARS-CoV-2 infection, MIS-C can also present with a strawberry tongue among its symptoms.

Streptococcal and Staphylococcal Infections

Infections caused by these bacteria can produce toxins that lead to systemic inflammation, including strawberry tongue.

Scarlet Fever

A streptococcal infection that causes a rash and symptoms similar to those of strawberry tongue.

Diagnostic Importance

Strawberry tongue is an important clinical sign that should alert healthcare professionals, including dentists, to the possibility of a serious underlying condition. Although a definitive diagnosis often requires further tests, the presence of this sign in the context of fever and other systemic symptoms can point towards specific diseases.

Clinical Case: An Example of Strawberry Tongue

Context

A 3-year-old child presents with painful oral lesions, accompanied by fever, fatigue, anorexia, and a skin rash. The clinical examination reveals a strawberry tongue with painful cervical lymphadenopathy.

Diagnosis

In this case, the clinical context is suggestive enough to suspect a condition like Kawasaki disease or a streptococcal infection. A check for proteinuria is recommended to rule out potential kidney complications.

Conclusion

Strawberry tongue is a clinical sign that should not be ignored. It can indicate various inflammatory or infectious conditions, notably Kawasaki disease and bacterial infections. Healthcare professionals should be vigilant when faced with this sign, especially in young children, and consider further examinations to make a precise diagnosis and initiate appropriate treatment. Early recognition of strawberry tongue can play a crucial role in the management and prognosis of these medical conditions.