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Fernando Daniel RH, Samantha PC, Adrián CO, Emilio Modesto TS, Edgar PB. Lipschütz ulcers: A diagnosis to be considered in the post-COVID-19 era. Int J STD AIDS 2024:9564624241289993. [PMID: 39361005 DOI: 10.1177/09564624241289993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Lipschütz ulcers (LU) represent a challenging and frequently overlooked diagnosis within the spectrum of genital ulcerations. We present the case of a 25-year-old sexually active woman with painful ulcerative lesions on her vulva, accompanied by general malaise, fatigue, and arthralgia. She had been suffering from mild COVID-19 for 1 month. Sexually transmitted infections and cytomegalovirus were excluded. A biopsy of the lesion confirmed a Lipschütz ulcer.
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Affiliation(s)
| | - Pérez-Cavazos Samantha
- Servicio de Infectología, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Camacho-Ortiz Adrián
- Servicio de Infectología, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Treviño-Salinas Emilio Modesto
- Servicio de Ginecología, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Pérez-Barragán Edgar
- Servicio de Infectología, Clínica Especializada Condesa Iztapalapa, Ciudad de México, México
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Evans JR, French AV. NASPAG Clinical Consensus on Non-sexually Acquired Genital Ulcers (Vulvar Aphthous Ulcers). J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00274-2. [PMID: 39197580 DOI: 10.1016/j.jpag.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri-menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.
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Affiliation(s)
- Jacquelyn R Evans
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Amanda V French
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
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Griffith T, Hunt M, Marathe K. Vulvar skin disease in the pediatric population. Curr Opin Pediatr 2024; 36:400-405. [PMID: 38832932 DOI: 10.1097/mop.0000000000001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW Vulvar skin disease is an underrecognized pediatric condition encompassing a wide range of conditions, from isolated vulvar disease to vulvar manifestations of systemic illnesses. This review highlights the most current research discussing clinical features, risk factors, and treatments. RECENT FINDINGS Recent studies confirm that labial adhesions resolve more quickly with estrogen treatment. Topical corticosteroids remain first-line for treatment of vulvar lichen sclerosus, and some procedural interventions are showing promising results. Latest evidence shows efficacy of biologic agents in hidradenitis suppurativa and vulvar Crohn's. Vaginal voiding remains an underrecognized cause of irritant vulvovaginitis. Lately vulvar aphthae have been associated with coronavirus disease 2019. Distinguishing between infantile perianal pyramidal protrusion, molluscum, and condyloma can be aided by differences in morphologic features. SUMMARY Vulvar dermatoses have a high impact on children's health and wellbeing. Clinician familiarity with recognition and latest advancements in vulvar dermatoses can aid in prompt diagnosis, management, and appropriate referrals. Vulvar biopsy and vaginal cultures should be used prudently. Treatments include topicals, behavioral modification, systemic medications, and procedures.
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Affiliation(s)
| | | | - Kalyani Marathe
- University of Cincinnati Department of Dermatology
- Cincinnati Children's Hospital Medical Center, Division of Dermatology, Cincinnati, Ohio, USA
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Brambilla I, Bolcato V, Volonté M, Querzani A, Guarracino C, Tondina E, Marseglia GL, Brazzelli V. Lipschütz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room. Int J Womens Dermatol 2024; 10:e122. [PMID: 38348354 PMCID: PMC10861013 DOI: 10.1097/jw9.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/23/2023] [Indexed: 02/15/2024] Open
Abstract
Background Primary acute genital ulcers, or Lipschütz ulcers (LU), are nonsexually transmitted, painful, self-limiting, nonrecurrent vulvar ulcers with unclear pathogenesis, representing a challenging diagnosis in emergency setting. LU have recently been described in association with severe acute respiratory syndrome coronaVirus 2 (SARS-CoV-2) infection and vaccination. Objective The aim of this study is to describe 2 cases of LU due to SARS-CoV-2 infection, highlighting the diagnostic process, differential diagnosis, disease course, and management options. Methods We describe 2 young females (12 and 9 years old) who presented to pediatric emergency room with the sudden onset of well-demarcated, painful, vulvar ulcers with fibrinous necrotic center. Results Both patients tested positive to SARS-CoV-2 nasal swab, and, at physical examination, no other lesions were found in other cutaneous or mucosal sites. Sexual abuse was excluded in both cases, as well as infectious and autoimmune diseases. Supportive analgesic therapy was administered, and complete remission of lesions was observed at follow-up visits without evidence of scarring. Limitations The main limitation of this work is represented by the small number of cases described. Conclusion Even though extremely rare, LU related to COVID-19 are an emerging entity to be considered in the diagnosis of acute genital ulcerations. Multidisciplinary diagnostic workup of genital ulcers must be established in order to exclude sexual child abuse, to ensure patient safety, and to avoid unnecessary treatment and familial anxiety.
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Affiliation(s)
- Ilaria Brambilla
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Bolcato
- Department of Public Health, Experimental and Forensic Medicine, Fondazione Istituto Neurologico Nazionale C. Mondino I.R.C.C.S., Unit of Legal Medicine, Pavia, Italy
| | - Martina Volonté
- Department of Clinical, Surgical and Pediatric Sciences, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Querzani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Carmen Guarracino
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Tondina
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical, Surgical and Pediatric Sciences, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
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Consolascio D, Bronz G, Lardelli PF, Milani GP, Lava SAG, Terziroli Beretta Piccoli B, Bianchetti MG, Bergmann MM, Rizzi M. Hoigné's syndrome, an uncommon mimicker of anaphylaxis: Systematic literature review. J Autoimmun 2024; 143:103164. [PMID: 38194789 DOI: 10.1016/j.jaut.2023.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
The term Hoigné's syndrome denotes a mimicker of anaphylaxis, which occurs immediately after the parenteral administration of a drug and is likely caused by non-thrombotic pulmonary and systemic drug micro-embolization. It has so far been documented uniquely in case reports and small case series. Because this condition has never been systematically evaluated, we performed a structured literature review (pre-registered as CRD42023392962). The search was carried out in Excerpta Medica, National Library of Medicine, and Google Scholar. Cases with features consistent with anaphylaxis, urticaria, angioedema, asthma, syncope, anxiety, or panic attack triggered by needle phobia, and local anesthetic systemic toxicity were excluded. For the final analysis, we retained reports published between 1951 and 2021, which presented 247 patients with Hoigné's syndrome: 37 children and 211 adults with a male: female ratio of 2.1 : 1.0. The patients presented within 1 min after parenteral administration of a drug (intramuscular penicillin in 90 % of the cases) with chest discomfort, shortness of breath, fear of death, psychomotor agitation, and auditory or visual hallucinations and impairment. Recovery occurred within 30 min. The diagnosis of Hoigné's syndrome was also established in five patients 66-91 years of age with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the aforementioned symptoms. It was therefore speculated that pulmonary drug micro-embolization induced a lethal cardiovascular compromise in these individuals. Histologic investigations supporting this hypothesis were performed in only one case. The diagnosis of Hoigné's pulmonary drug micro-embolization was established also in five patients with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the afore mentioned symptoms. Histologic investigations supporting this hypothesis were performed in only one case. In conclusion, Hoigné's syndrome is an uncommon non-immune-mediated reaction. This report seeks to promote broader awareness and knowledge regarding this alarming mimicker of anaphylaxis. Diagnosis relies solely on clinical evaluation.
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Affiliation(s)
- Danilo Consolascio
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro F Lardelli
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
| | - Benedetta Terziroli Beretta Piccoli
- Epatocentro Ticino, Lugano, Switzerland; Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, United Kingdom; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marcel M Bergmann
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Mattia Rizzi
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Oncology/Hematology Unit, Department of Women-Mother-Child, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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