Lingual Linear Lesions: A Clinical Sign Strongly Suggestive of Severe Vitamin B12 Deficiency

Nutr Clin Pract. 2021 Oct;36(5):1041-1048. doi: 10.1002/ncp.10596. Epub 2020 Oct 30.


Background: Lingual linear lesions (LLLs) are the oral linear lesions located on the dorsum, lateral borders, and/or ventral surface of tongue. It has been suggested that LLLs might be an early clinical sign of vitamin B12 deficiency. Here, a retrospective study was conducted to further investigate and validate the association between LLL and vitamin B12 deficiency.

Methods: Based on the clinical examination, patients with LLLs were enrolled and analyzed retrospectively. Data regarding clinical and laboratory features were obtained. Follow-up was done at least 6 months following appropriate supplementation therapy.

Results: A total of 57 patients, consisting of 20 males and 37 females with a mean age of 59.12 years (range, 18-80), were enrolled in this study. The hematological examination revealed that 56 (98.25%) of the 57 patients had severe serum vitamin B12 deficiency, and the other 1 patient had a borderline low level of vitamin B12 . All the enrolled patients responded well to cobalamin replacement therapy.

Conclusion: LLLs might be a clinical sign strongly suggestive of severe vitamin B12 deficiency.

Keywords: hydroxycobalamin; lingual lesion; tongue; vitamin B12; vitamin B12 deficiency.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Vitamin B 12 Deficiency* / complications
  • Vitamin B 12 Deficiency* / diagnosis
  • Vitamin B 12 Deficiency* / drug therapy
  • Vitamin B 12*
  • Vitamins
  • Young Adult


  • Vitamins
  • Vitamin B 12