Gangrene of the tongue is unusual given its rich vascular supply. The clinical presentation can be startling. We were surprised to see a florid case in a patient after a myocardial infarction.
A 68-year-old retired engineer with a history of coronary artery disease, sleep apnea, transient ischemic attacks, and congestive heart failure was admitted to the hospital after a cardiac arrest at home. Paramedics found him in ventricular fibrillation and performed defibrillation three times, followed by tracheal intubation. The patient suffered a second cardiac arrest and again required defibrillation. In the coronary care department, the patient was unresponsive and developed edema and ecchymosis of the tongue. An otolaryngologist initiated treatment with erythromycin 500 mg intravenously every 6 hours prophylactically. Three days later, infectious disease consultation was requested because of fever to 39.1°C. The tongue was edematous, protuberant, blackened, and foul smelling, with purulent exudate from around the endotracheal tube. He