What Causes Strawberry Tongue?

Strawberry tongue is a term for a tongue that is swollen and bumpy. It is not a health condition but rather a symptom of another disease.

Some health conditions that may lead to strawberry tongue include bacterial infections, viral infections, and Kawasaki disease.

This article explains a strawberry tongue's symptoms, causes, and treatment.

Symptoms of Strawberry Tongue

Strawberry tongue typically presents with the following symptoms:

• Tongue rash
• Swollen tongue
• Increased tongue size
• Small bumps on the tongue that look like strawberry seeds
• Redness on the tongue

Because strawberry tongue indicates a medical condition, if you experience these symptoms, contact a healthcare provider for a diagnosis.

Causes of Strawberry Tongue

Bacterial or viral infections and Kawasaki disease are common causes of strawberry tongue.

Scarlet Fever

Scarlet fever is a bacterial infection caused by group A strep. In addition to strawberry tongue, scarlet fever also causes a fever, sore throat, and a red skin rash.

Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a bacterial infection caused by Streptococcus (strep), Staphylococcus, and Clostridium bacteria. TSS presents with high fever, headache, muscle aches, gastrointestinal symptoms, and, more rarely, strawberry tongue. It is associated with tampon use but can occur in anyone of any gender and age.

Yellow Fever

Yellow fever is a (rarely fatal) viral disease transmitted by mosquitos. Symptoms include headache, fever, jaundice (yellow skin), muscle pain, nausea, vomiting, and strawberry tongue.

Kawasaki Disease

Kawasaki disease is an acute illness brought on by a fever in young children. It commonly results in strawberry tongue as well as other symptoms, such as fever, rash, swelling of the hands and feet, red eyes, and inflamed mouth, lips, and throat.

Recurrent Toxin-Mediated Perianal Erythema

Recurrent toxin-mediated perianal erythema is a bacterial infection caused by Streptococcus. This infection is more common in young adults. Symptoms include fever, strawberry tongue, and red, flaky hands.

Recalcitrant Erythematous Desquamating Disorder

Recalcitrant erythematous desquamating disorder is a staphylococcal bacterial infection similar to TSS. Its symptoms include fever, hypotension (low blood pressure), and strawberry tongue.

Yersinia Pseudotuberculosis

Yersinia pseudotuberculosis is a zoonotic bacterial infection found among farm and wild animals, which can pass to humans through food and water contamination. Symptoms include fever, abdominal cramps, vomiting, diarrhea, and sometimes, strawberry tongue.

Food or Drug Allergies

You may get strawberry tongue due to a medication or food allergy. This usually presents with other allergy symptoms, like congestion, itching, and drainage.

How to Treat Strawberry Tongue

How to treat strawberry tongue depends on the cause. Some treatments may involve:

• Antibiotics (for bacterial infections)
• IV immune globulin and aspirin (for Kawasaki disease)
• IV fluids
• Pain relievers and fever reducers (for yellow fever)
• Antihistamines (for allergies)

Typically, the symptoms will also disappear when the condition causing strawberry tongue resolves.

Complications and Risk Factors Associated With Strawberry Tongue

Strawberry tongue does not pose a risk in and of itself. However, plenty of complications are associated with the conditions that cause it.

Bacterial infections can lead to a more serious infection called sepsis (when an infection moves into the bloodstream). Sepsis is a life-threatening emergency resulting in organ dysfunction, amputation, and death.

With yellow fever, some people will develop a severe illness, resulting in shock and organ failure. The fatality rate of severe disease is between 30-60%.

Kawasaki disease complications include damage to the coronary (heart) arteries. As many as a quarter of kids with Kawasaki disease will develop heart complications. When the coronary artery is weakened, it increases the risk of aneurysms.

There is always a risk of a severe allergic reaction called anaphylaxis, a life-threatening emergency. Anaphylaxis symptoms include difficulty breathing, throat tightness, swelling, trouble speaking, dizziness, and a feeling of doom.

Are There Tests to Diagnose the Cause of Strawberry Tongue?

As with treatment, tests that accompany a diagnosis depend on which cause a healthcare provider suspects. Blood and fluid sample tests can usually pinpoint bacterial and viral infections.

There is no definitive test for diagnosing Kawasaki disease. Instead, a healthcare provider will diagnose this condition through a physical exam and rule out other potential causes.

They can also diagnose allergies through an allergy test or by eliminating the suspected allergen and watching for a resolution of the symptoms.

When to See a Healthcare Provider

Because many serious health conditions can cause strawberry tongue, seeing a healthcare provider when you experience these tongue symptoms is always best. Seek immediate medical care if you notice any of the following:

• Confusion
• Shortness of breath
• Rapid heart rate
• Fever
• Cold sweats
• Extreme pain
• Clammy or sweaty skin

These could indicate a more serious situation, like sepsis or anaphylaxis.

Summary

Strawberry tongue is a tongue that is swollen, red, and bumpy, taking on the appearance of a strawberry. Many factors, including bacterial and viral infections and Kawasaki disease, can cause this symptom. Getting rid of strawberry tongue involves treating the underlying cause. Because some serious health conditions can cause strawberry tongue, you should always see a healthcare provider for an accurate diagnosis and treatment.