Black Tongue?

Some what of a quirky phenomenon, yet hoping for elements of a diagnostic pearl the question rang in the back of my mind as I saw this poorly ( ?malnourished though more debilitated )appearing woman. The research on this topic re differentials was not as fruited as I'd hoped yet the mystique prevails as I feel there are gems still to be unearthed. Hairy leukoplakia ( black hairy tongue with the copy righted Mayo clinic photo is what most literature points to http://www.mayohealth.org/home?id=HQ00325 . Still its presence in uremia , some pneumonias is mentioned and the overall suggestion is that this is non-specific , caused by accumulated bacteria that good oral hygiene readily eliminates.

Its association with pellagra is mentioned as is its presence with antibiotics ??? and bismuth containing medicines ie PeptoBismol. Mayo suggest smoking or use (abuse) tobacco agents

pellagra or Niacin deficiency has often been called the disease of the four D's -- dermatitis, diarrhea, dementia, and death

"This is the remains of a lesion on the back of the hand of an elderly man. There is a certain amount of redness, roughness and pigmentation which is a natural change rather than a result of the pellagrous eruption. There is however, a certain amount of redness due to the 'new skin' following desquamation."

Interestingly this lady perked up on B vitamins though tongue remained black.Discussing personal hygiene with patients is an area I am trying to develop .

Thanks to Dr Carlos Escoffery -Pathology UHWI for his input re this topic.