Median Rhomboid Glossitis — ORE Part 1 MCQ

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ModerateOral MedicineMedian Rhomboid GlossitisORE Part 1

A patient presents with a localised area of redness on the midline posterior dorsum of the tongue, devoid of filiform papillae. It is well-demarcated, painless, and has been present for years. A swab shows Candida albicans. What is the most likely diagnosis?

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Correct answer: A — Median rhomboid glossitis

Median Rhomboid Glossitis (MRG) is the correct diagnosis. The clinical presentation matches all diagnostic hallmarks: a well-demarcated, smooth, red, rhomboid area of papillary atrophy on the midline posterior dorsum of the tongue, immediately anterior to the circumvallate papillae. The painless, long-standing nature (present for years) and positive Candida albicans swab are characteristic—Candida is found in approximately 90% of MRG cases. MRG is benign and requires no treatment if asymptomatic. Option B (carcinoma) is unlikely given the painless, asymptomatic, stable course. Option C (geographic tongue) presents as irregular, migratory, non-midline patches, not the focal rhomboid depapillation of MRG. Option D (atrophic lichen planus) typically shows reticular or erosive patterns on buccal mucosa and palate, not midline posterior dorsum depapillation. Option E (syphilitic glossitis) presents with pain, induration, and malignant potential, inconsistent with this benign, painless lesion.

Reference: Median Rhomboid Glossitis: A Case Study (2024), PubMed (PMID: 38933609); and NICE Evidence summary on Candida – oral (SDCEP, 2013): https://www.evidence.nhs.uk/document?id=1643730