From the Guidelines
Strawberry tongue is primarily caused by inflammatory and infectious conditions, including Kawasaki disease, multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2, and other viral and bacterial infections.
Common Causes of Strawberry Tongue
- Kawasaki disease: a condition characterized by fever, rash, and mucocutaneous findings, including strawberry tongue, as described in the American Heart Association statement 1
- MIS-C: a rare complication of SARS-CoV-2 infection, with clinical features including fever, mucocutaneous findings, and strawberry tongue, as reported in the American College of Rheumatology clinical guidance 1
- Viral infections: such as measles, adenovirus, enterovirus, and Epstein-Barr virus, which can cause similar clinical findings, including strawberry tongue 1
- Bacterial infections: such as scarlet fever, staphylococcal scalded skin syndrome, and toxic shock syndrome, which can also present with strawberry tongue 1
Important Considerations
- Strawberry tongue is a nonspecific finding and can occur in various conditions, making it essential to investigate other possible causes and consider the clinical context 1
- The diagnosis of MIS-C, in particular, requires careful evaluation and consideration of the prevalence and chronology of SARS-CoV-2 infection in the given location 1
From the Research
Causes of Strawberry Tongue
The causes of strawberry tongue can be attributed to various diseases and conditions, including:
- Toxic shock syndrome (TSS) caused by Staphylococcus aureus or Streptococcus pyogenes, which can produce toxins leading to strawberry tongue 2, 3
- Kawasaki disease, an acute systemic vasculitis that can cause strawberry tongue, among other symptoms 4
- Scarlet fever, caused by Streptococcus pyogenes, which can lead to strawberry tongue or raspberry tongue 2, 5
- Group A streptococcal pharyngitis, which can also cause strawberry tongue 3
Associated Conditions
Strawberry tongue can be associated with other conditions, such as:
- Exanthematous disease, which can be mediated by toxic shock syndrome toxin-1 (TSST-1) 3
- Necrotizing fasciitis, a severe condition that can occur in children and young adults 2
- Chronic or relapsing furonculosis, caused by Staphylococcus aureus producing Panton-Valentine leucocidin 2
Oral Manifestations
Strawberry tongue can be an oral manifestation of systemic diseases, and dental professionals should be aware of its early symptoms to facilitate prompt diagnosis and treatment 5