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American Journal of Medical Sciences and Medicine. 2016, 4(4), 71-76
DOI: 10.12691/ajmsm-4-4-1
Open AccessCase Report

Linezolid Induced Black Hairy Tongue an Uncommon Phenomenon: A Case Report with Update of Review of Literature

Rakesh Tilak Raj1, , Rajnish Raj2, Jitender Nagpal2 and Raj Kumar3

1Department of Dermatology and Venereology and Leprosy, Government Medical College and Rajindra Hospital, Patiala, India

2Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, India

3Department of Pharmacology, GGS Medical College (Baba Farid University of Health Sciences), Faridkot, India

Pub. Date: July 22, 2016

Cite this paper:
Rakesh Tilak Raj, Rajnish Raj, Jitender Nagpal and Raj Kumar. Linezolid Induced Black Hairy Tongue an Uncommon Phenomenon: A Case Report with Update of Review of Literature. American Journal of Medical Sciences and Medicine. 2016; 4(4):71-76. doi: 10.12691/ajmsm-4-4-1


As the use of newer antibiotics like Linezolid is tremendously increasing due to their efficacy and safety against methicilin resistant staphylococcus aureus and Vancomycin resistant entero-cocci, its rarer side effect like black hairy tongue is often overlooked. Case presentation: A 26 year-old-male, reported with asymptomatic black hairy tongue (BHT) on tenth day after taking Linezolid 600mg twice daily for his left foot infection. His tongue examination was consistent with black hairy tongue. He neither exhibited any predisposing factor nor any history of substance abuse or drug except Linezolid and prompt withdrawal of drug led to complete resolution of BHT on seventh day. Re-challenge test revoked similar response on tenth day. WHO-UMC causality scale showed certain adverse drug reaction and on Naranjo’s adverse drug reaction probability scale score of 10 indicates definite association. Conclusion: This case report is highlighted due to its rarity, self-limiting and reversible condition. The purpose of the paper is to create awareness amongst medical fraternity about Linezolid induced Adverse Drug Reaction.

Oxazolidinone Naranjo’s algorithm adverse event Linezolid Lingua villosa nigra DSM-5 HADS

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[1]  Jover-Diaz-F., Cuadrado-Paster, J.,M, Talents- Bolos, A., Martin-Gonzalez, C, Black tongue associated with Linezolid, Am J Ther,17(4).115-117. 2010.
[2]  Noskin, G.,A, Methicilin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci: emerging problems and new prospects for management, Ann Acad Med Singapore, 30.320-331. 2001.
[3]  Hau, T, Efficacy and safety of Linezolid in the treatment of skin and soft tissue infections, Eur J Clin Microbiol infect Dis, 21.491-498. 2002.
[4]  Sarti, G.,M, Haddy, R.,I, Schaffer, D., Kihm, J, Black hairy tongue, Am Fam Physician, 41.1751-1755. 1990.
[5]  Tamam, L., Annagur, B.,B, Black hairy tongue associated with olanzapine treatment: a case report, Mt Sinai J Med, 73.891-894. 2006.
[6]  MacGrath, E.,E, Bardsley, P., Basran, G, Black hairy tongue what is your call? CMAJ, 178.1137-1138. 2008.
[7]  The use of the WHO-UMC system for standardized case causality assessment, [Accessed at http// on June 18th, 2014].
[8]  Naranjo, C.,A, Busto, U., Sellers, E.,M, Sander, P., Ruiz, I., Roberts, E.,A. et al., A method for estimating the probability of adverse drug reactions, Clin Pharmacol Ther, 30.239-245. 1981.
[9]  American Psychiatric Association, Diagnostic and Statistical manual of mental disorders, 5th ed., American Psychiatric Association, Washington DC, 2013.
[10]  Bjelland, I., Dahl, A.,A, Haugg, T.,T, Neckelmann, D, The validity of the hospital Anxiety and Depression Scale: an update literature review. J Psychosm Res, 52.69-77. 2002.
[11]  Spielberger, C., D, Gorsuch, R.,L, Lushene, P.,R, Vagg, P.,R., and Jacobs, G., A, Manual for State-Trait Anxiety Inventory: Bibliography (2nd ed) Palo Alto, CA: Consulting Psychologists Press, 1983.
[12]  Beneke, M., Rasmus, W, ‘Clinical global impressions’ (ECDEU): some critical comments, Pharmacopsychiatrie, 25.171-176. 1992.
[13]  Thompson, D.,F, Kessler, T.,L, Drug induced black hairy tongue, Pharmacotherapy, 30.585-593. 2010.
[14]  Gerson, S.,L, Kaplan, S.,L, Bruss, J.,B, Le, V., Arellano, F.,M, Hafkin, B, et al., Hematological effects of Linezolid: summary of clinical experience, Antimicrob Agents Chemother, 46(8). 2723-2726. 2002.
[15]  Manabe, M., Lim, H.,W, Winzer, M., Loomis, C.,A, Architectural organization of filiform papillae in normal and black hairy tongue epithelium: dissection of differentiation pathways in a complex human epithelium according to their patterns of keratin expression, Arch Dermatol, 135.177-181. 1999.
[16]  Harada, Y., Gaafar, H, Black hairy tongue, A scanning electron microscopic study, J Laryngol Otol, 91.91-96. 1977.
[17]  Prinz, H, Black tongue, Br Dent J, 46.1265-1274. 1925.
[18]  Vano-Galvan, S., Jaen, P, Black hairy tongue, Cleve Clin J Med, 75. 847-848. 2008.
[19]  Gurvits, G., E, Tan, A, Black hairy tongue syndrome, World J Gastroenterol, 20(31). 10845-10850. 2014.
[20]  Balaji, G., Maharani, B., Ravichandran, V., Parthasarathi, T, Linezolid induced Black hairy tongue, Indian J Pharmaco, 46.653-654. 2014.
[21]  Langtry, J., A., A, Carr, M., M, Steele, M.,C. et al., Topical tretinoin: a new treatment for black hairy tongue (lingua villosa nigra), Clin Exp Dermatol, 17.163-164. 1992.
[22]  Matson, K., L, Miller, S.,E, Tooth discoloration after treatment with Linezolid, Pharmacotherapy, 23(5).682-685. 2003.
[23]  Amir, K., A, Bobba, R.,K, Clarke, B., Nagy-Agren, S., Arsura, E.,L, Balogun, S., A , et al., Tongue discoloration in an elderly kidney transplant recipient: treatment related adverse event? Am J Geiatr Pharmcother, 4.260-263.2006.
[24]  Refaat, M., Hyle, E., Malhotra, R., Seidman, D., Dey, B, Linezolid induced lingua villosa nigra, Am J Med, 121. 2008.e1.doi: 10.1016/j.amjmed.2008.02.023.
[25]  Ma, J.,S, Teeth and tongue discoloration during Linezolid therapy, Pediatr Infect Dis J, 28(4).345-346. 2009.
[26]  Bozkurt, I., Yontar, I., Doganay, M, Black hairy tongue: a rare side effect of Linezolid, Our Dermatol Online, 3(2).136-137. 2012.
[27]  Marina, V.,P, Kasmani, R, An uncommon side effect of Linezolid, Int J Urol Nephrol, 44.995-996. 2012.
[28]  Khasawneh, F., A, Moti, D.,F, Zorek, J.,A, Linezolid induced black hairy tongue: a case report, J Med Case Rep, 7(1).46. 2013.
[29]  Aijazi, I., Abdulla F., M, Linezolid induced Black hairy tongue: A rare side effect, J Ayub Med Coll Abbottabad, 26(3).401-403. 2014.
[30]  Petropoulou, T., Lagona, E., Syriopoulou, V., Michos, A, Teeth and tongue discoloration after Linezolid treatment in children, Pediatr infect Dis J, 32.1284-1285. 2013.
[31]  Santos, J., A, Varandas, L., Gouveia, C, Reversible teeth discoloration in children: A linezolid therapy side effect, Clin Pediatr, 54(8).809. 2015.
[32]  Mancano, M., A, High-Dose Loperamide Abuse Inducing Life-Threatening Cardiac Arrhythmias; Topiramate-Induced Diarrhea in a Breastfed Infant; Danazol-Induced Stevens-Johnson Syndrome; Asenapine-Induced Myasthenic Syndrome;Black Hairy Tongue Due to Linezolid; Adalimumab-Induced Priapism, Hosp Pharm, 50(5):351-5. 2015 May.
[33]  Kobayashi K., Takei Y., Sawada M., Ishizaki S., Ito H., Tanaka M, “Dermoscopic Features of a Black Hairy Tongue in 2 Japanese Patients,” Dermatology Research and Practice, 2010.