A 78-year-old man presented to the clinic with complaints of fever, painful glossitis, and abnormalities in taste that was persistent for one month. The patient had a history of end-stage renal disease, diabetes mellitus, and microscopic polyangiitis and was on glucocorticoid therapy.
Physical examination of the tongue showed a large, punched-out painful ulcer. Tongue biopsy revealed numerous neutrophils, lymphocytes, plasma cells, and large cells with cytoplasmic inclusions.