A 38 year old female patient reported with the complaint of burning and tingling sensation in her tongue with intolerance to spicy food for the past 2 months. The patient also reported of occasional tingling sensation in the hands and feet since 2 months. On General examination, pallor of conjunctiva was evident. Oral examination revealed depapillated tongue with sparse inflamed and hypertrophic papillae denuded above the dorsal surface of tongue (Fig. 1). Patient also had angular cheilitis. Hematological investigations undertaken confirmed anaemia and the peripheral blood smear (Fig. 2) showed megaloblasts suggestive of megaloblastic anaemia. Serum vitamin B12 level was estimated and was found to be 156 ng/L, suggestive of vitamin B12 deficiency. Hence, a diagnosis of strawberry tongue secondary to megaloblastic anaemia was established. Peripheral neuropathy secondary to megaloblastic anemia was suspected and the patient was referred to a general medicine specialist for further evaluation. The patient was administered oral cyanocobalamin 1000 mcg/day and folic acid 5 mg/day for a period of three months and improvement in the symptoms and blood parameters were noted. Complete remission of the tongue findings was observed by the end of two months.

Strawberry tongue is a rare finding seen in various disorders such as Kawasaki disease, scarlet fever, Vitamin B12 deficiency anaemia. Careful examination of the oral findings can aid the oral physician or dental surgeon to diagnose the underlying systemic disease and direct the patient towards appropriate investigations and referral.

Fig. 1 Bald and erythematous tongue with sparse hypertrophic papilla giving appearance of strawberry tongue.

Fig. 2 Peripheral blood smear under 100 × magnification showing macrocytic RBCs with hyper segmented neutrophils.

© The authors, 2022

All Figures

	Fig. 1 Bald and erythematous tongue with sparse hypertrophic papilla giving appearance of strawberry tongue.
In the text

	Fig. 2 Peripheral blood smear under 100 × magnification showing macrocytic RBCs with hyper segmented neutrophils.
In the text