An asymptomatic hyperpigmented tongue

A 60-year-old woman presented with a 1-week duration of a macular pigmentation of her tongue. The physical examination revealed a black tongue and enlarged filiform papillae; the rest of the patient's oral mucosa was pink (Fig 1). No lymphadenopathy was noted and the patient had no significant medical history. On further questioning, the patient mentioned that she had recently began vaping cappuccino-flavored electronic cigarettes in the week before her presentation. She was not inhaling but instead was holding the vapor in her mouth.

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