Black Hairy Tongue: An Uncommon Manifestation of Linezolid Therapy

A 30-year-old male underwent pilonidal sinus surgery. After completing 14 days of Linezolid therapy, brownish discolouration of the tongue was noted, which could not be wiped off with gauze and the patient was diagnosed with black hairy tongue (BHT) due to Linezolid therapy [Figure 1]. Other known causes such as poor oral hygiene, smoking, alcohol or substance abuse were ruled out. The Naranjo’s adverse drug reaction (ADR) probability scale resulted in a score of 7 (0–10), which corresponds to a probable ADR.^[1] The patient was advised to maintain good oral hygiene and clean his tongue with a soft toothbrush. Complete resolution of the lesions was seen after 2 weeks [Figure 2].

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Figure 1:

Brownish-black discolouration on the posterior aspect of the tongue 2 weeks after Linezolid therapy.

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Figure 2:

Complete resolution of lesions 2 week after discontinuation of Linezolid.

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Ren et al., reported, 19 cases of antibiotic-induced BHT and the culprits were Linezolid in ten cases, amoxicillin-clavulanate in four cases, minocycline in two cases and erythromycin, doxycycline, and metronidazole in one case each.^[2] Mannu et al., reported a case of Linezolid-induced BHT.^[3]

It is a self-limiting condition and is also known as Lingua Villosa Nigra. A fraction (0.2%) of cases treated with Linezolid can have BHT and in few cases, tooth discoloration has also been reported. The proposed mechanism is alteration in the usual flora of mouth and growth of chromogenic bacteria resulting in discoloration. A hairy appearance could be facilitated by inadequate desquamation.^[2]