A 41-year-old woman was referred by her general dentist to the general surgery
department of hospital. Her chief complaint was difficulty in eating certain types of food (mainly
banana and tomato) because of a burning sensation and the presence of red stains on the inside of
her cheeks and on her tongue. She had been a strict vegetarian and had not consumed milk, cheese
or eggs since last 2 years. She was not taking any medication. The current symptoms had been
present for more than a year. Her past medical history of partial gastractomy in January’ 2016 and
she reported no history of allergy. During clinical evaluation, paleness and dry lips were detected.
The patient also displayed a disturbance of taste (she was unable to sense the flavour of a variety of
fruits and vegetables), fatigue after simple daily activities, disturbance of memory and slowing
mental faculty, characterized by forgetting recent facts, dates, appointments and difficulty in
answering simple questions, respectively. Oral examination revealed pale oral mucosa, glossitis
with papillary atrophy and multiple areas of painful erythema on the dorsal surface and lateral
borders of the tongue and buccal mucosa as shown in below figures.
The mucosa covering the lesions appeared atrophic, but no frank ulceration was evident as shown in
Laboratory tests were done and report was as mentioned below.
Neutrophil nuclei were hyper-segmented, with more than 5