Oral Thrush (Candidiasis): This condition is characterized by a white tongue and can be accompanied by red spots or patches, especially if there is an associated inflammatory response. It's common in individuals with poor oral hygiene, immunocompromised states, or those using inhaled corticosteroids.

Geographic Tongue: A benign condition that can cause red, smooth patches on the tongue, giving it a "geographic" appearance. While it doesn't typically cause a white tongue, the red spots could be a prominent feature, and the white appearance might be due to another concurrent condition like oral thrush.
Kawasaki Disease: Although more common in children, Kawasaki disease can occur in adults and is characterized by fever, rash, swelling of hands and feet, conjunctivitis, and oral changes including a red, swollen tongue that might appear white due to debris or secondary infection.
Vitamin Deficiencies (e.g., Vitamin B12, Iron, Folate): Deficiencies in these vitamins can lead to changes in the tongue's appearance, including redness and atrophy of the papillae, which might give a white appearance due to the loss of the normal papillary structure.

AIDS or HIV Infection: Oral manifestations such as oral thrush, hairy leukoplakia, and Kaposi's sarcoma can be early signs of HIV infection. A white tongue with red spots could be indicative of an opportunistic infection in an immunocompromised patient.
Leukemia: Certain types of leukemia can cause oral changes, including a white tongue due to infection or infiltration of the tongue by leukemic cells. Red spots could represent petechiae or bleeding due to thrombocytopenia.
Lymphoma: Similar to leukemia, lymphoma can cause a variety of oral manifestations, including changes in the tongue's appearance, due to either direct involvement or secondary effects like immunosuppression.

Pemphigus Vulgaris: An autoimmune disease that can cause blistering of the skin and mucous membranes, including the tongue. While rare, it could potentially cause a white tongue with red spots due to erosions and secondary infections.
Erythema Multiforme: A skin condition that can also affect the mucous membranes, causing red, target-like lesions. Involvement of the tongue could lead to a white appearance with red spots due to the disease process and secondary changes.
Lichen Planus: A chronic inflammatory condition that can affect the skin, mouth, and other areas. Oral lichen planus might cause a white, lacy appearance on the tongue, and red spots could be present if there's an erosive component.