Tareen and Grossman 360 (20): e26, Figure 1 May 14, 2009

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A 55-year-old male nonsmoker with multiple myeloma refractory to chemotherapy was admitted to the hospital for autologous stem-cell transplantation. Palifermin was to be administered before and after the transplantation. On completion of the 3-day infusion of palifermin before transplantation, an asymptomatic, white, adherent plaque developed, coating the tongue. Culture revealed normal oral flora, without candida. Oral mucositis did not develop, and the white plaque faded, without treatment, over a 1-week period and did not recur during the post-transplantation administration of palifermin. The patient was discharged 2 weeks after the successful transplantation. Palifermin, a recombinant keratinocyte growth factor, is used for the prevention of oral mucosal injury induced by cytotoxic therapy in patients undergoing hematopoietic stem-cell transplantation. Palifermin stimulates the proliferation and differentiation of epithelial cells. The white tongue is commonly observed in patients treated with palifermin and most likely reflects transient, protective mucosal thickening.