Hyperpigmentation of the tongue has been demonstrated by chemotherapy, particularly with cytotoxic drugs, yet the precise pathophysiological mechanism remains poorly understood [1].

Drug-induced pigmentation accounts for at least 20% of all cases of acquired pigmentation [2]. Antineoplastic agents have been demonstrated in the pigmentation of mucous membranes and nails [3].

Herein, we report the case of a 78-year-old patient followed for metastatic hepatic sigmoid ADK and carcinosis under capecitabine-type chemotherapy who presented grade II hand-foot syndrome (Figs. 1a and 1c) and hyperpigmentation of the tongue (Fig. 1b) after the third session of capecitabine. She was placed on symptomatic treatment with a one-week interruption in her treatment with improvement in the symptomatology. However, the hyperpigmentation failed to disappear completely; it persists yet in an attenuated manner.

Figure 1: (a) Tongue hyperpigmentation after the third session of capecitabine, (b and c) Hand-foot syndrom grade II and hyperpigmentation after the third session of capecitabine.

Such cases as this is a challenge for healthcare professionals and patients as they draw attention to the importance of documentation in improving patient care in the management of side effects associated with certain medications [1].

REFERENCES

1. Lucia Moreira Gil, Joana Marques, Duarte Salgado. Hyperpigmentation de la langue associée au témozolomide en monothérapie:étude de cas. Port Acta Med. 3 février 2022.

2. Nahhas AF, Braunberger TL, Hamzavi IH. An update on drug-induced pigmentation. Am J Clin Dermatol. 2019;20:75-96

3. Casamiquela KM, Cohen PR. Chemotherapy-associated tongue hyperpigmentation and blue lunula. J Drugs Dermatol. 2013;12:223-6.