Hairy Tongue Induced by Piperacillin-Tazobactam

A 65-year-old male, diagnosed with Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome and extended-spectrum beta-lactamase Escherichia coli urosepsis, was initiated on intravenous piperacillin-tazobactam. After 1 week of antibiotic therapy, he developed black discolouration of the tongue. On examination, the dorsum of the tongue showed black, elongated filiform papillae with a characteristic carpet-like appearance [Figure 1]. A clinical diagnosis of antibiotic-induced black hairy tongue was made, and the patient was advised to maintain proper oral hygiene.

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Figure 1:

Black discolouration noted over the dorsal surface of the tongue.

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Black hairy tongue, or lingua villosa nigra, is a rare and benign condition characterised by hypertrophy and defective desquamation of filiform papillae, leading to a black discolouration of the tongue. Its prevalence varies between 0.6% and 11.3%. Common predisposing factors include alcohol consumption, smoking, poor oral hygiene and the use of certain medications such as doxycycline, minocycline, amoxicillin-clavulanate and piperacillin-tazobactam. The condition typically resolves with the withdrawal of the causative agent and adherence to good oral hygiene practices.