Candidiasis of the tongue in cannabis users: a report of 2 cases

Cannabis, a psychoactive drug widely used for medicinal, recreational, and religious purposes, can have detrimental effects on several body systems, including the respiratory, cardiovascular, and central nervous systems. The use of cannabis in cigarette form can produce a series of oral alterations, including periodontitis, caries, xerostomia, a decreased salivary pH, and an increase in the density of Candida albicans. However, the occurrence of oral candidal lesions related to cannabis use is little reported in the literature. This article reports 2 cases of oral candidiasis associated with cannabis use. The adult male patients, both of whom were systemically healthy, had white and red spots consistent with oral candidiasis on the dorsal surface of the tongue. One of the patients also had a red lesion on an area of the hard palate that was in contact with the affected area of the tongue. Neither patient was currently undergoing antibiotic or corticosteroid treatment, and both reported frequent smoking of cannabis. One patient was initially treated with an oral suspension of nystatin without clinical improvement. Miconazole gel therapy was then prescribed, and clinical improvement was observed after 2 weeks. The patient did not stop smoking cannabis, and a recurrence of oral candidiasis was observed 6 months posttreatment. Treatment with miconazole gel was repeated, resulting in resolution of the infection. The second patient declined treatment. The reported cases demonstrate that, although it is infrequently reported, oral candidiasis may occur in cannabis smokers.

Keywords: cannabis; marijuana abuse; marijuana smoking; oral candidiasis; oral manifestations.