Physicians use food to describe the body: Analogies add flavor, provide a lingua franca for description, and offer a mnemonic. Presenting medicine in food descriptors makes a boundless field easier to digest. We present a selection of food terms pertaining to physical diagnosis.
Skin
Food terminology provides a tasteful way to describe sometimes unsightly cutaneous disorders. Warts can be described as cauliflower or fig, and angiomas as cherry or strawberry. The bullous vesicles of dyshidrosis are likened to tapioca pudding. Rhinophyma, incorrectly attributed to alcoholism, is described as a strawberry nose.
Several skin lesions resulting from infection are berry-like: the mulberry rash of typhus, the framboisiform lesionsof yaws or syphilis, and the blueberry muffin appearance of infants with congenital rubella or cytomegalovirus. Staphylococcal impetigo presents as honey-colored crusts. One may believe that Salmonella is derived from salmon-colored patches seen in typhoid, but this organism was actually named for pathologist Daniel Salmon; thesalmon-colored patches of Still’s disease are named for their piscine similarity.
Many systemic diseases have dermatologic manifestations. Examples include peaches-and-cream (or pig skin) complexion of myxedematous hypothyroidism and peach fuzz lanugo of anorexia. Malignancy appears as peau d’orange in breast cancer or as the paraneoplastic drumstick fingers associated with lung cancer and the tripe palms suggesting an aerodigestive tumor.1Cafe-au-lait spots are seen with neurofibromatosis but appear in other genetic disorders and can be normal. A port wine stain over half the face is characteristic of Sturge-Weber syndrome and indicates an ipsilateral brain arteriovenous malformation.
Eye
The ophthalmoscope brings to light a cornucopia of ailments. Cherry red macula signifies central retinal artery occlusion but appears in some sphingolipidoses, mucopolysaccharidoses, temporal arteritis, and cryoglobulinemia. Hyperviscosity syndrome can cause the retinal blood vessels to assume a sausage string appearance: “The vein swells…between arteriovenous crossing points and thus resembles a string of sausages (more like bratwurst, knackwurst, or boudin than andouille).”2 Cytomegalovirus causes a pepperoni pizza appearance of the retina. These white patches of edema with hemorrhage also have been called “cottage cheese and ketchup.”3 Diffuse retinal epithelial mottling causes a “salt and pepper” appearance, seen in congenital syphilis or rubella. Resolving retinitis from acute retinal necrosis caused by varicella-zoster virus is Swiss cheese-like, as the retinitis regresses from the leading edge and from venules within the lesion.4
Oral Cavity
From berries to caviar, the mouth contains a refined palate of culinary analogy. The strawberry tongue, suggesting inflammatory changes of Kawasaki’s disease, scarlet fever, or toxic shock syndrome, has diagnostic utility. On a case series of Kawasaki disease, it was present in 71% of patients with true disease but in only 27% of patients with mimics.5 The same fruit lends its name to the painful strawberry gums of granulomatosis with polyangiitis.6 A discussion of berries in the mouth is incomplete without the toothsome mulberry molars of congenital syphilis.7
Glossitis, seen in nutritional deficiencies, infections, and infiltrative processes, is often described as a beefy red tongue.8 Ironically, beef can prove therapeutic for B-vitamin or iron deficiency. Although the dorsal surface of the tongue has been well examined, the ventral surface is overlooked; it may reveal deep purple caviar lesions, indicating sublingual varicosities associated with portal hypertension or advanced age.9
Genitals
Although culinary terms are used to describe genitals colloquially, medical terminology has avoided such comparisons. Exceptions include cottage cheese discharge associated with candidiasis10; strawberry cervix, denoting inflammation in the setting of infection11; and fishy odor of bacterial vaginosis or trichomoniasis. Wet mount shows clue cells in the former and motile pear-shaped protozoa in the latter. The male member has not been spared culinary comparison: An eggplant deformity of the penis is caused by fracture of the tunica albuginea.12
Sputum
Sputum color may be a useful adjunct in diagnosis. The currant jelly sputum of Klebsiella pneumoniae is “so tenacious and jelly-like that the cup [of sputum] can often be inverted without the loss of any.”13Legionellapneumonia may produce orange-colored sputum because this organism produces an orange pigment.14Moraxellapneumonia sputum is occasionally apple green.15 Other rare culinary descriptions include the anchovy paste of liver abscess eroding into lung16 and the expectorated rice bodies of pulmonary tuberculosis representing granulomatous particles of caseous necrosis.13
Urine
Like other effluvia, urine provides valuable clues for the culinary competent. Patients with glomerulonephritis produce Coca-Cola or coffee-colored urine, although this finding can be seen in rhabdomyolysis or hemolysis. A urine connoisseur recognizes the Bordeaux red color seen occasionally in porphyria, although the precise vintage reflects the hematoporphyrin content, ranging from port wine to cherry red.17Milk urine, or chyluria, indicates lymphatic obstruction due to parasitic infection, granulomatous disease, lymphatic malformation, renal malignancy, or even aortic aneurysm.18, 19 On the other hand, color can reflect metabolites of a recent meal; after eating beets, 14% of people experience the vivid red urine of beeturia.20
Stool
Although a resemblance between feces and food stretches imagination, a smattering of such terms appear in the medical literature. Red-currant jelly stool is tied only loosely to intussusception, because less than 10% of patients have the characteristic mucoid, bloody diarrhea.21 The association between cholera and rice-water stool is neither perfectly sensitive nor specific: Early cholera can present with bilious yellow stools,22 and diarrhea associated with arsenic poisoning has been likened to rice water.23 Interestingly, rice water (the food) may be a treatment for diarrhea and an alternative to oral rehydration, being both calorically rich and osmotically active.24
Conclusions
In 1979, Terry and Hanchard25 compiled a collection of culinary terms in medicine, which has grown subsequently.26, 27 We expand this literature focusing on physical diagnosis. One might argue against the use of food descriptors in medicine: Regional variability limits use28; who among us, Terry and Hanchard ask, would recognize the inside of a nutmeg? However, culinary metaphors add color and spice to an otherwise bland litany of Latin labels and technical terms. Food terms provide a foundation in the familiar. Perhaps this is why culinary comparisons abound in medical patois, not only in the world of physical diagnosis but also in anatomy, pathology, and radiology. Food, whether common or exotic, works as a metaphor because it represents a universal language. Although many have never seen a nutmeg, the description of nutmeg liver remains apt and, importantly, memorable.
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– Nicholas M. Mark, MDcorrespondenceemail, Juan N. Lessing, MD, Sarah A. Buckley, MD, Lawrence M. Tierney Jr., MD
This article originally appeared in the September 2015 issue of The American Journal of Medicine.
