An Unusual Traumatic Ulceration of the Tongue

We report a case of an 11-month-old girl who was referred to us for fever, difficult feeding with progressive weight loss and a painful ulcer on the ventral surface of the tongue. Her clinical history was characterised by a perinatal hypoxic-ischaemic brain injury. The intra-oral examination revealed an ulcerative lesions extending from the tip to the ventral surface of the tongue. It was ovoid, well circumscribed, with raised and indurated edges and with a yellowish fibrinous base (Fig. 1a,c – lower arrow). Biochemical analysis, immunological and genetic studies were normal; cultivation of the lesion revealed flora saprophyte. As neurological examination revealed a multifocal dystonia including abnormal movements of the oro-facial musculature that caused the impact of the tongue between the lower central incisors, the diagnosis of ‘late Riga-Fede disease’ (RFD) was considered. The electroencephalogram (Fig. 1b) showed bihemispheric slow frequency rhythms, while the brain magnetic resonance imaging showed a thinning of the