口腔灼熱症(burning mouth syndrome, BMS)是一種慢性疼痛症候群，特徵為持續性口腔黏膜灼熱、刺痛或感覺異常，臨床檢查常無明顯病灶。病因尚未完全明瞭，可能與神經病變及心理因素有關。全球盛行率約為1.73%，以女性與50歲以上族群好發。由於對本病症了解有限，臨床醫師常延遲診斷或誤診為念珠菌感染、胃食道逆流等其他疾病，被提出的治療方式雖多但大多實證不足，通常需個人化合併療法，包括抗癲癇藥物、抗焦慮藥物、抗憂鬱藥物及低能量雷射治療等。

本文報告一位61歲女性病人，主訴舌尖及上顎刺痛三個月，伴隨重度憂鬱症狀。經實驗室檢查排除其他全身性疾病，最終診斷為BMS合併憂鬱症及念珠菌感染。初步藥物治療配合低能量雷射治療後，症狀獲得明顯改善，疼痛指數由嚴重降為輕微且間歇性發作，憂鬱情緒亦顯著緩解。

本個案凸顯灼口症的診斷及治療之臨床挑戰性，提醒醫師面對持續性口腔疼痛且無明顯病灶的病人時，需提高對口腔灼熱症的警覺，排除可能的共病症，並透過藥物及非藥物治療的調整，以改善病人的生活品質與治療預後。

Burning mouth syndrome (BMS) is a chronic pain disorder characterized by persistent burning, stinging, or abnormal sensations in the oral mucosa, often in the absence of visible clinical lesions. Its etiology remains unclear, although it has been associated with neuropathic changes and psychological factors. The global prevalence is approximately 1.73%, with higher rates noted in women and individuals over 50 years of age. Due to the limited understanding of this condition, BMS is frequently under- or misdiagnosed as other conditions, such as candidiasis or gastroesophageal reflux disease. Although numerous treatment options have been proposed, most lack strong evidence. Management typically requires personalized combination therapy, including anticonvulsants, anxiolytics, antidepressants, and low-level laser therapy.

This article reports a case of a 61-year-old female patient who presented with tongue tip and palatal pain lasting three months, accompanied by severe depressive symptoms. Laboratory tests ruled out other systemic diseases, and the final diagnosis was BMS with concurrent severe depression and candidiasis. Following initial medication combined with low-level laser therapy, her symptoms improved significantly: pain intensity decreased from severe to mild with intermittent episodes, and depressive mood lessened.

This case highlights the clinical challenges in diagnosing and treating BMS, emphasizing the need for physicians to remain vigilant when encountering patients with persistent oral pain without obvious lesions. Identifying potential comorbidities and employing a combination of pharmacological and non-pharmacological therapies can improve treatment outcomes, thereby enhancing the patient’s quality of life.