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A 77-year-old woman presented with an insidious onset of fatigue and a burning sensation of the tongue on swallowing food. Six years earlier, she had undergone a total gastrectomy for early gastric cancer, which was curative. On physical examination, she was pale and had a depapillated, smooth, shiny red tongue with some central fissuring, findings that were consistent with a beefy red tongue (Panel A). Laboratory testing revealed cytopenia (white-cell count, 3400 per cubic millimeter; hemoglobin level, 6.4 g per deciliter; and platelet count, 154,000 per cubic millimeter) with macrocytosis (mean corpuscular volume, 132 fl [normal range, 80 to 100]; . . . [Full Text of this Article] |
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