From the Guidelines
Purple tongue discoloration is most likely caused by Kawasaki disease, which is characterized by changes in lips and oral cavity, including erythema and cracking of lips, strawberry tongue, and diffuse injection of oral and pharyngeal mucosae. This condition is a leading cause of morbidity and mortality in children, and prompt diagnosis and treatment are crucial to prevent long-term complications 1.
Key Points to Consider
- Kawasaki disease is a systemic vasculitis that affects medium-sized arteries, particularly the coronary arteries, and can cause a range of symptoms, including fever, rash, and lymphadenopathy 1.
- The changes in lips and oral cavity, including strawberry tongue, are a key diagnostic feature of Kawasaki disease 1.
- Other potential causes of purple tongue discoloration, such as medication side effects, nutritional deficiencies, and infections, are less likely to be associated with the characteristic symptoms of Kawasaki disease.
Important Considerations for Diagnosis and Treatment
- A diagnosis of Kawasaki disease should be considered in any child who presents with a fever, rash, and lymphadenopathy, particularly if they also have changes in their lips and oral cavity 1.
- Prompt treatment with intravenous immunoglobulin and aspirin can help to reduce the risk of long-term complications, such as coronary artery aneurysms 1.
- It is essential to seek medical attention promptly if a purple tongue is accompanied by other symptoms, such as pain, swelling, or difficulty breathing, to determine the underlying cause and recommend appropriate treatment.
From the Research
Causes of Purple Tongue Discoloration
- Vascular and lymphatic lesions, such as infantile hemangiomas and oral varices, can cause changes in tongue color, including purple discoloration 2
- Certain infections, like those caused by herpes simplex and varicella-zoster virus, can also lead to tongue discoloration, although purple is not specifically mentioned 2
- A study on patients with coronary heart disease found that some patients exhibited a bluish-purple tongue, which was associated with an increased risk of acute cardiovascular events 3
- Anticoagulant therapy, particularly with warfarin, can cause cutaneous reactions, including the "purple toe syndrome," which may be related to purple tongue discoloration 4, 5
- Heparin-induced thrombocytopenia can also lead to lingual hematoma, which may cause tongue discoloration, including purple color 6
Systemic Diseases and Purple Tongue Discoloration
- Systemic diseases, such as nutritional deficiency and systemic amyloidosis, can manifest in the tongue, including changes in color, although purple is not specifically mentioned 2
- Coronary heart disease has been associated with tongue manifestations, including bluish-purple tongue, which may be related to blood-stasis and toxin syndrome 3
Other Possible Causes
- Reactive and inflammatory processes, such as hairy tongue and benign migratory glossitis, can cause changes in tongue color, although purple is not specifically mentioned 2
- Premalignant and malignant lesions, such as leukoplakia and squamous cell carcinoma, can also affect the tongue, although their relationship to purple discoloration is unclear 2