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A 24-year-old man presented with black discoloration and hairy appearance of his tongue, which he had had for 2 days, and a sore throat. He had been taking ciprofloxacin and doxycycline for the past week for an upper respiratory tract infection. He did not smoke or use oral tobacco products, and he was not taking any bismuth-containing compounds. Physical examination revealed white tonsillar exudates and a black discoloration of the tongue; no fever, adenopathy, or hepatosplenomegaly was noted. The results of a rapid streptococcal-antigen test and a monospot test were negative. A throat culture was positive for Candida albicans. Black hairy tongue (lingua villosa nigra) may be associated with the presence of chromogenic organisms (e.g., C. albicans) and the use of certain medications (e.g., doxycycline and bismuth). Whether the effects of doxycycline and C. albicans are synergistic in producing a black, hairy tongue is unknown. The pathophysiology is thought to be due to proliferation of the filiform papillae of the tongue, which stain black with porphyrin-producing chromogenic bacteria or yeast. The doxycycline was discontinued, and the patient was treated with a short course of fluconazole. The black discoloration and hairy appearance of the tongue resolved in 3 days.
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