探讨利奈唑胺致黑毛舌的临床诊断学特征。

回顾性分析2020年9月26日吉林大学白求恩第一医院神经内科门诊收治的1例细菌性脑膜炎(不除外结核)患者使用利奈唑胺后出现黑毛舌的临床资料，并复习相关文献，分析利奈唑胺致黑毛舌的可能机制、临床诊断学特征及防治策略。

患者女性，37岁，因"头痛、发热伴恶心呕吐1周"入院，诊断为细菌性脑膜炎(不除外结核)。对患者行利奈唑胺联合抗结核药物治疗，应用利奈唑胺18 d后患者舌背变为黑色，23 d后出现明显的毛发样改变，期间患者自觉舌背有异物感。停用利奈唑胺30 d后，患者舌背黑色舌苔完全消退，口腔异常感觉消失。结合相关文献分析，患者服用利奈唑胺后黑毛舌出现的中位时间为14.0(12.0，21.0)d，病情好转停药后黑毛舌消失的平均时间为(13.4±6.6)d。黑毛舌的主要表现是舌背出现丝状乳头的伸长和肥大，呈棕色或黑色改变，在排除微生物感染的前提下，其诊断主要依赖视诊观察，在停药及消除危险因素后黑毛舌消失。

黑毛舌可能与利奈唑胺用药相关，临床可以通过舌丝状乳头的伸长和肥大及舌背棕黑色变色等特征进行观察诊断。

To investigate the clinical diagnostic characteristics of linezolid-induced black hairy tongue.

The clinical data of a patient with black hairy tongue after linezolid treatment in the Department of Neurology, the First Bethune Hospital of Jilin University on September 26, 2020 were retrospectively analyzed. Additionally, relevant literature was reviewed to analyze the possible mechanism, clinical diagnostic characteristics, and prevention and treatment strategies of linezolid-induced black hairy tongue.

A 37-year-old female patient was admitted to the hospital for 1 week due to symptoms of headache, fever, nausea, and vomiting. Her diagnosis was bacterial meningitis (tuberculosis could not be ruled out). The patient was prescribed linezolid in combination with anti-tuberculosis medication. After 18 days of linezolid treatment, the dorsum of her tongue turned black, and visible hair-like alterations emerged after 23 days. Thirty days after stopping linezolid, the black tongue covering on the dorsum of the tongue vanished, so did the odd sensation in the oral cavity. Combined with the relevant literature, the median appearance time of black hairy tongue after taking linezolid was 14.0 (12.0, 21.0) days, while the average disappearance time of black hairy tongue after quitting linezolid was (13.4±6.6) days. Black hairy tongue was characterized by the extension and hypertrophy of the filiform papillae, as well as brown or black staining on the posterior dorsum of the tongue. On the assumption of excluding microbiological infection, the diagnosis of black hairy tongue relied on visual observation, and it would subside following drug withdrawal and the elimination of risk factors.

Black hairy tongue may be associated with the use of the linezolid. Clinically, the diagnosis can be made by the elongation and hypertrophy of the filiform papillae and the brown or black discoloration of the dorsum of the tongue.