Chronic Inflammatory Tongue Lesion in an Elderly Immunocompromised Female with Familial Predisposition: A Case Report

Tongue lesions are often quite difficult to diagnose. This is especially true in older adults and those with weakened immune systems because such lesions can be even more difficult and can even seem to be premalignant and/or infectious lesions. They can be caused by immune and/or nutritional dysregulation, as well as by more systemic illnesses. This report describes a 71-year-old female with Chronic Lymphocytic Leukaemia (CLL) and autoimmune arthritis who presented with a persistent, painful ulcerative lesion on the mid-dorsal surface of the tongue. The lesion had been present for six months and was associated with occasional spontaneous bleeding. Comprehensive clinical, haematologic, and radiologic evaluation ruled out fungal infection and malignancy. Histopathology revealed epithelial atrophy with subepithelial inflammatory infiltrate, consistent with a benign chronic inflammatory process. Also, remarkable was the family background of this patient, as her mother suffered an undiagnosed condition for many years and her brother had a fissured tongue, or a tongue with deep grooves, but had no symptoms of any disease, which could point to a possible hereditary condition in that family. The patient was diagnosed and managed conservatively with a mouthwash with benzydamine, mucopain, and vitamin A and multivitamin supplements, which improved the ulcer by 90% in the eight weeks and complete symptom resolution on follow-up at 12 weeks. This case underscores the importance of a systematic, multidisciplinary approach in evaluating chronic tongue lesions in immunocompromised individuals. Early recognition of benign inflammatory patterns can prevent unnecessary invasive investigations and patient anxiety. The co-existence of autoimmune and haematologic disorders, along with familial occurrence, further highlights the multifactorial nature of such lesions and their relevance in oral medicine practice.