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Saberi SA, Kumar AM, Davis D, Nambudiri VE. Florid cutaneous morbilliform eruption in the setting of primary Epstein-Barr virus infection. JAAD Case Rep 2024; 45:102-105. [PMID: 38434596 PMCID: PMC10907508 DOI: 10.1016/j.jdcr.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Affiliation(s)
| | - Anusha M. Kumar
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dale Davis
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vinod E. Nambudiri
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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2
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Saunders NA, Welch KC, Haefner HK, Rasmussen C, Margesson L. Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment. J Low Genit Tract Dis 2024; 28:73-75. [PMID: 37906578 DOI: 10.1097/lgt.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES Vulvar ulcers can be challenging to diagnose, manage, and treat. Ulcers can be nonspecific in appearance and have many etiologies. Description of the lesion is very important. METHODS An interactive vulvar ulcer algorithm was created to aid in the evaluation, diagnosis, and treatment of vulvar ulcers. RESULTS The algorithm flowchart begins with careful history and physical examination. Pending these, specific tests can be obtained to aid in diagnosis. The algorithm also links to appropriate treatments. The algorithm can be accessed on the International Society for the Study of Vulvovaginal Disease Web site ( issvd.org ). Each underlined word in the algorithm is a hyperlink that leads to a wealth of information on the topic that providers can use to direct testing and aid in diagnosis and treatment. CONCLUSIONS The vulvar ulcer algorithm can help clinicians with diagnosis and treatment plans.
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Affiliation(s)
- Natalie A Saunders
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Kathryn C Welch
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Hope K Haefner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Merlino L, Volpicelli AI, Dominoni M, Pasquali MF, D’Ovidio G, Gardella B, Senatori R. Lipschütz Ulcer and SARS-CoV-2: What We Currently Know? Diseases 2023; 11:121. [PMID: 37754317 PMCID: PMC10528082 DOI: 10.3390/diseases11030121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND In recent years, several interesting case reports have been published which describe the possible role of SARS-CoV-2 infection or vaccination in the etiopathogenesis of Lipschütz ulcer. Our aim is to analyze this association and provide a rapid algorithm that is of support to gynecologists and dermatologists both in the diagnosis and in setting up the therapy. To do so, in this paper, we describe an interesting case of acute vulvar ulcer triggered by SARS-CoV-2 infection and review the related literature. METHODS We conducted a literature review including papers published between October 2021 and April 2023, and we described the case of a patient referred to our clinic with Lipschütz ulcer and SARS-CoV-2 infection. RESULTS In almost all cases analyzed, a correlation with SARS-CoV-2 infection or vaccination was found; ulcers usually manifest after 2 to 4 weeks and are associated with flu-like symptoms. A concordance in review papers, as well as in our case report, was also found about the treatment, which is mainly symptomatic. CONCLUSIONS Previous infection or vaccination for SARS-CoV-2 should be included as possible etiopathogenetic factors in the onset of Lipschütz ulcer.
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Affiliation(s)
- Lucia Merlino
- Department of Medical-Surgical Sciences and Biotechnologies, Sapeinza University of Rome, 00161 Rome, Italy
| | - Agnese Immacolata Volpicelli
- Department of Medical-Surgical Sciences and Biotechnologies, Sapeinza University of Rome, 00161 Rome, Italy
- Department of Maternal Infantile and Urological Sciences, Sapeinza University of Rome, 00161 Rome, Italy
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, 27100 Pavia, Italy
| | - Marianna Francesca Pasquali
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia D’Ovidio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapeinza University of Rome, 00161 Rome, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, 27100 Pavia, Italy
| | - Roberto Senatori
- Italian Society of Colposcopy and Cervicovaginal Pathology (SICPV), 00186 Rome, Italy
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4
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Rein J, Watkins B. Acalculous Cholecystitis in a Seven-Year-Old Girl With Epstein-Barr Virus Infection. Cureus 2021; 13:e19774. [PMID: 34950552 PMCID: PMC8687799 DOI: 10.7759/cureus.19774] [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] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
Epstein-Barr virus (EBV) infection with associated acute acalculous cholecystitis (AAC) has been reported in 18 pediatric patients. Our case is that of a seven-year-old girl with acute EBV infection and associated AAC.
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Affiliation(s)
- Jeffrey Rein
- Pediatrics, Southern Arizona Veterans Affairs (VA) Health Care System, Tucson, USA.,Pediatrics, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
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5
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Lipschütz's acute vulvar ulcer: a systematic review. Eur J Pediatr 2020; 179:1559-1567. [PMID: 32296983 DOI: 10.1007/s00431-020-03647-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022]
Abstract
In previously healthy subjects, vulvar ulcers are mostly caused by sexually transmitted microorganisms. Lipschütz's acute vulvar ulceration, first reported in 1912, is a non-sexually acquired condition characterized by sudden onset of a few genital ulcers. We systematically review presentation, underlying causes, and disease duration of Lipschütz's ulceration. A comprehensive source of Excerpta Medica, National Library of Medicine, and Web of Science databases was performed. Reports including cases of apparently previously healthy females affected by Lipschütz's ulceration were selected. A predefined database was used to extract data on demographics, history, clinical and microbiological findings, and treatment.The search disclosed 158 cases. Almost 90% of cases were ≤ 20 years of age and sexually inactive. Lesions were usually one to about three, painful, ≥ 10 mm large, well-delimited, with a fibrinous and necrotic center and a symmetric distribution. Voiding disorders and enlarged inguinal lymph nodes were observed in a large subset of cases. Canker sores were noted in 10% of patients. Lipschütz's vulvar ulceration occurred concomitantly with an infectious disease in 139 cases. Infectious mononucleosis syndrome (N = 40) was the most frequently detected well-defined infection, followed by mycoplasma species infections (N = 11). The disease resolved after ≤ 3 weeks.Conclusions: Lipschütz's ulceration mainly affects both sexually inactive and, less frequently, sexually active subjects ≤ 20 years of age, presents with ≤ 3 vulvar ulcers, resolves without recurrences within 3 weeks and is temporarily associated with an infection, most frequently a flu-like illness or an infectious mononucleosis syndrome. What is Known: • Lipschütz's acute vulvar ulceration is a non-sexually acquired condition, which is characterized by a sudden onset of a few necrotic and painful genital ulcers. • The condition tends to resolve spontaneously and is usually triggered by an infection. What is New: • The condition mainly affects subjects ≤ 20 years of age, tends to resolve within 3 weeks, and is usually temporarily associated with a flu-like illness or an infectious mononucleosis syndrome. • Systemic corticosteroids do not reduce disease duration.
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6
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Chu J, Genisca A, Kaziny B. Case 1: Concurrent Upper Respiratory Tract Infection and Vulvar Ulcers in a Teenage Girl. Pediatr Rev 2018; 39:258-259. [PMID: 29716968 DOI: 10.1542/pir.2016-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jamie Chu
- Department of Pediatrics-Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Alicia Genisca
- Department of Pediatrics-Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Brent Kaziny
- Department of Pediatrics-Emergency Medicine, Baylor College of Medicine, Houston, TX
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7
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Higgins CL, Howard A. A case of post-partum non-sexually acquired genital ulceration. Australas J Dermatol 2017; 58:e256-e257. [PMID: 28691366 DOI: 10.1111/ajd.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire L Higgins
- Vulval Dermatology Clinic, Royal Women's Hospital, Parkville, Victoria, Australia.,Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Anne Howard
- Vulval Dermatology Clinic, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Dermatology, Western Health, Footscray, Victoria, Australia.,Inner West Dermatology, Footscray, Victoria, Australia
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8
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Wolters V, Hoogslag I, Van' T Wout J, Boers K. Lipschütz Ulcers: A Rare Diagnosis in Women With Vulvar Ulceration. Obstet Gynecol 2017; 130:420-422. [PMID: 28697104 DOI: 10.1097/aog.0000000000002145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lipschütz ulcers are characterized by painful vulvar ulceration, most commonly in young women. Because these lesions are so rarely seen, the diagnosis can be challenging. CASE An 18-year-old woman, without any prior sexual activity, developed painful blue vulval lesions. These became necrotizing ulcers, and she began antiviral therapy for presumptive herpes infection. Herpes cultures, however, were negative. Serology consistent with a recent Epstein-Barr virus infection resulted in a diagnosis of Lipschütz ulcers. CONCLUSION Lipschütz ulcers, associated with acute Epstein-Barr virus infection or other viral and bacterial infections, are a type of nonsexually transmitted vulvar ulceration. It is important to avoid selective attention to sexually transmitted infections as the etiology to avoid unnecessary antiviral therapy and immune suppressants. By considering other etiologies, the patient will be spared potentially embarrassing persistent questioning about her sexual history.
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Affiliation(s)
- Vera Wolters
- Departments of Gynecology and Obstetrics and Internal Medicine, Haaglanden Medical Center location Bronovo, The Hague, Academic Medical Center, Amsterdam, and the Department of Infectious Diseases and Immunology, Leiden University Medical Center, Leiden, the Netherlands
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9
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Staykova J, Belovska T, Murad A, Kakid S, Nacheva A, Shikova E. Cervical Viral Infections among Asymptomatic Bulgarian Women. Cent Eur J Public Health 2017; 24:176-179. [PMID: 27760284 DOI: 10.21101/cejph.a4299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/25/2016] [Indexed: 11/15/2022]
Abstract
AIM Although sexually transmitted viral infections are significant and increasing public health concern, little is known about their prevalence among Bulgarian women. The aim of this study was to investigate cervical viral infections in asymptomatic women. METHODS The study group included 52 randomly selected asymptomatic female volunteers from Bulgarian border town Kardzhali. Cervical specimens were tested by real-time PCR for human papillomaviruses (HPV), herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). RESULTS The investigation demonstrated a high rate (61.5%) of infection with one or more viruses of uterine cervix of participating women considered at low risk. The most prevalent was HPV, found in 32.7% of all women. The genotyping of high-risk (HR) HPV positive specimens showed that HPV16 was the most prevalent HR type. HSV prevalence (30.8%) was almost as high as that of HPV and most women were HSV1 infected. 9.6% and 5.8% of all specimens were positive for EBV and CMV, respectively. CONCLUSIONS Our results indicate that women from Kardzhali region, involved in this study, might be at risk for development of genital tract pathology, including cervical cancer, and for transmission of virus infection sexually and perinatally.
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Affiliation(s)
- Jeni Staykova
- Regional Health Inspectorate, Kardzhali, Bulgaria.,Faculty of Public Health, Medical University, Sofia, Bulgaria
| | | | - Ayla Murad
- Regional Health Inspectorate, Kardzhali, Bulgaria
| | | | | | - Evelina Shikova
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
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10
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Cymerman RM, Kaplan Hoffmann R, Rouhani Schaffer P, Pomeranz MK. Vulvar infections: beyond sexually transmitted infections. Int J Dermatol 2017; 56:361-369. [DOI: 10.1111/ijd.13464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/24/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel M. Cymerman
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Rachel Kaplan Hoffmann
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Panta Rouhani Schaffer
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
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11
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Lymphocytic Arteritis in Epstein-Barr Virus Vulvar Ulceration (Lipschütz Disease): A Report of 7 Cases. Am J Dermatopathol 2016; 37:691-8. [PMID: 26291418 DOI: 10.1097/dad.0000000000000316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epstein-Barr virus (EBV) infection can rarely present as painful genital ulcers, mostly in young female adolescents. Typically diagnosed by clinical findings, EBV vulvar ulceration (EBVVU) is rarely biopsied. Herein, the authors report the histopathology in 8 biopsies from 7 EBVVU patients, all serologically confirmed for acute (4/7) or reactivated-chronic (3/7) EBV infection. The 7 women all presented with 1 or more painful, punched-out vulvar ulcers. Only patients with acute EBV infection showed other clinical findings: fever and/or atypical lymphocytosis affected 75% (3/4); lymphadenopathy in 50%; and malaise/fatigue, dysuria and/or hepatomegaly in 25%. All reactivated-chronic EBVVU had a solitary ulcer, and 2 had history of a similar episode of vulvar ulceration (aphthosis). Histopathologically, lymphocytic arteritis was identified in 88% (7/8); a submucosal scar was found in the eighth specimen. Other histopathologies included venulitis (62%), endarteritis obliterans (38%), thrombosis (25%), neutrophilic sebaceous adenitis (25%), and mucosal lymphoid hyperplasia (12%). Dense angiocentric CD3 CD4 T-cell lymphocyte-predominant infiltrates were found, regionally or diffusely. In 2 specimens, neutrophils compromised half of the infiltrate. Minor components of CD8, CD20, and CD30 lymphocytes, CD123 plasmacytoid monocytes, CD68 macrophages, and plasma cells were present. Small-vessel endothelium and smooth muscle adjacent to the ulcers faintly expressed cytoplasmic EBV latent membrane protein-1 (LMP1). In situ hybridization for early EBV mRNA (EBER) identified rare solitary or scattered clustered positive lymphocytes in 38%. Polymerase chain reaction for EBV DNA was positive in one EBER positive biopsy. EBV infection has been documented in muscular vessel vasculitis. Based on the aforementioned, EBVVU appears to be the consequence of localized lymphocytic arteritis.
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12
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Visentin D, Driul L, Buligan C, Angarkhayeva A, Pinzani C, Martina MD, Londero A, Stinco G. Ulcus vulvae acutum - A case of genital ulcers in adolescent girl. Case Rep Womens Health 2015; 9:4-6. [PMID: 29594011 PMCID: PMC5863025 DOI: 10.1016/j.crwh.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Ulcus vulvae acutum is a rare clinical condition characterized by the presence of multiple acute painful genital ulcers of non-venereal origin associated with systemic symptoms in young women. The aetiopathogenesis of the disease is not fully understood, although recent reports have associated it with the Epstein–Barr virus. Diagnosis is difficult and generally made by exclusion after venereal diseases, and autoimmune, inflammatory, traumatic, and neoplastic causes. We describe a case of adolescent female with an episode of ulcus vulvae acutum associated with infectious mononucleosis. The diagnosis was supported by the clinical symptoms, elevated circulating levels of liver enzymes, positive EBV serology, cervical and inguinal lymphadenomegaly, and hepatosplenomegaly. The patient presented a history of aphthous stomatitis. Negative Pathergy test and the absence of any other related symptoms allowed us to exclude the Behçhet syndrome. Lesions healed with no sequelae or recurrences.
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Affiliation(s)
- Daniela Visentin
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Cinzia Buligan
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Ayuna Angarkhayeva
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Caterina Pinzani
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Monica Della Martina
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Ambrogio Londero
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
| | - Giuseppe Stinco
- Clinic of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine (DISM), University of Udine, Italy.,Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Italy
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13
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14
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Choi HY, Nickless D, Tee W, Tong E, Aboltins CA. Acute scrotal ulcers in typhoid Fever: case report and literature review. Trop Med Health 2014; 43:69-73. [PMID: 25859155 PMCID: PMC4361342 DOI: 10.2149/tmh.2014-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/09/2014] [Indexed: 11/11/2022] Open
Abstract
Background. In developed countries, typhoid fever is a travel-associated disease that is often overlooked. However, as standard blood and stool culture methods have relatively low sensitivity, diagnosis depends heavily on clinical signs and symptoms and on a high level of suspicion. Methods. Reported here is the case of an 18-year-old male who presented with fever and acute scrotal ulcers and whose blood cultures were positive for Salmonella enterica serotype Typhi. A review of genital ulcers associated with typhoid fever in the literature is discussed. Conclusion. This report suggests that typhoid fever is a differential diagnosis of acute genital ulcers.
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Affiliation(s)
- Hil Yin Choi
- University of Melbourne, Northern Clinical School , Epping, Victoria, Australia, 3040
| | - David Nickless
- Department of Pathology, Northern Health , Victoria, Australia
| | - Wennie Tee
- Department of Medicine, Northern Health , Victoria, Australia
| | - En'en Tong
- Department of Medicine, Northern Health , Victoria, Australia
| | - Craig A Aboltins
- Department of Infectious Diseases, Northern Health , Victoria, Australia ; University of Melbourne, Northwest Academic Centre , Victoria, Australia
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15
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16
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Park BM, Ahn JS, Lee JB, Won YH, Yun SJ. Chronic active Epstein-Barr virus infection-associated hydroa vacciniforme-like eruption and Behçet's-like orogenital ulcers. Dermatology 2013; 226:212-6. [PMID: 23751255 DOI: 10.1159/000348709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022] Open
Abstract
The cutaneous manifestations of chronic active Epstein-Barr virus (EBV) infection can be diverse. Among them, hydroa vacciniforme-like eruption is one of the best-known features. Although rare, mucosal ulcers have been reported to be associated with EBV as a result of primary infection or immune suppression. We describe a 65-year-old female with recurrent necrotic papulovesicles on the face and both arms for 2 years. She also complained of recurrent oral and genital mucosal ulcers developing simultaneously with skin eruptions. They appeared periodically during the spring and summer and were triggered or aggravated by sun exposure. Skin biopsies from the face and genitalia showed identical findings with dense lymphocytic infiltrations. In addition, in situ hybridization revealed EBV-positive lymphoid cells in both specimens. To our knowledge, this is the first case of serologically and pathologically proven chronic active EBV infection presenting hydroa vacciniforme-like eruption and orogenital ulcers at the same time in one patient.
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Affiliation(s)
- B M Park
- Department of Dermatology, Chonnam National University Medical School, Gwangju, South Korea
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17
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Abstract
BACKGROUND Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia. METHODOLOGY Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis. RESULTS The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established. CONCLUSIONS H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.
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18
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Brinca A, Canelas MM, Carvalho MJ, Vieira R, Figueiredo A. Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion. An Bras Dermatol 2012; 87:622-4. [DOI: 10.1590/s0365-05962012000400018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/18/2011] [Indexed: 11/21/2022] Open
Abstract
Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.
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Affiliation(s)
- Ana Brinca
- University of Coimbra Hospitals, Portugal
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19
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Abstract
Lipschütz ulcer (LU) is an uncommon condition that usually affects prepubertal and pubertal girls. It can be misdiagnosed as a sexually transmitted disease or even as a sign of child abuse, causing great anxiety to patients and their families. We present two cases of LU consecutively affecting twin sisters. To our knowledge, this is the first case in two family members, supporting infectious transmission. We propose airborne transmission as the most probable cause in our cases.
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Affiliation(s)
- Maria T Truchuelo
- Department of Dermatology, University Ramón y Cajal Hospital, Madrid, Spain.
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20
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Abstract
Acute genital ulcers are painful and distressing to women and perplexing to the providers who care for them. The differential diagnosis includes sexually and nonsexually transmitted infections, autoimmune conditions, drug reactions, and local manifestations of systemic illness. However, in many cases, no causative agent is identified, and lesions are classified as idiopathic aphthosis. In the setting of fever and acute onset of genital ulcers in girls and women, the term Lipschutz ulcers has been used to describe ulcers associated with an immunologic reaction to a distant source of infection or inflammation. The aims of this article are to review the differential diagnosis and pathogenesis of acute genital ulcers, to offer an evaluation and classification scheme, and to discuss treatment options for the dermatologist who cares for women and girls with vulvar ulcers.
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Affiliation(s)
- Jill S Huppert
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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21
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Abstract
Vulvar edema is associated with a variety of conditions. The edema can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumors and iatrogenic causes. At times, it is difficult to determine the cause of the vulvar edema. Treatment consists of determining the origin of the edema and giving the appropriate therapy for that diagnosis as well as the use of compression and, at times, lymphatic massage.
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Affiliation(s)
- Yaa Amankwah
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
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22
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Non-Sexually Transmitted Acute Ulcer of the Vulva Associated With Influenza A Virus Infection. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/s1578-2190(11)70756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Esteve-Martínez A, López-Davia J, García-Rabasco A, Febrer-Bosch I, Miquel VAD. [Non-sexually transmitted acute ulcer of the vulva associated with influenza A virus infection]. ACTAS DERMO-SIFILIOGRAFICAS 2010; 102:63-4. [PMID: 21315865 DOI: 10.1016/j.ad.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/26/2010] [Accepted: 04/05/2010] [Indexed: 11/27/2022] Open
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Abstract
Epstein-Barr virus (EBV) is best known as the organism responsible for the syndrome of acute infectious mononucleosis. Transmission of EBV most commonly occurs through oral secretions. EBV has also been isolated from the female genital tract, where its role is poorly understood. This article reviews the available literature and data regarding EBV in the female genital tract and discusses areas of consensus and controversy. The primary manifestation of EBV seems to be vulvar ulcers, which are underrecognized. Diagnosis relies on appropriate serologic testing. Management includes local care and may require pain and corticosteroid medications. Although EBV is present elsewhere in the female genital tract, its pathogenic role in the cervix, uterus, fallopian tubes, and ovaries is poorly understood.
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Lehman JS, Bruce AJ, Wetter DA, Ferguson SB, Rogers RS. Reactive nonsexually related acute genital ulcers: review of cases evaluated at Mayo Clinic. J Am Acad Dermatol 2010; 63:44-51. [PMID: 20462661 DOI: 10.1016/j.jaad.2009.08.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 08/15/2009] [Accepted: 08/17/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reactive nonsexually related acute genital ulcers (RNSRAGU) occur in pubertal girls after an acute systemic infection. OBJECTIVE We sought to characterize RNSRAGU by reviewing the medical records of patients with this disorder. METHODS We searched our medical index database from 1997 to 2007 for RNSRAGU cases. Questionnaires were mailed to identified patients. RESULTS The study included 10 patients; 5 responded to the questionnaire. The mean age at onset was 11.5 years. Vulvar ulcers were preceded by viral gastroenteritis (n = 3), viral upper respiratory tract infection (n = 3), streptococcal pharyngitis (n = 1), influenza (n = 1), and other nonspecific febrile illnesses (n = 2). Seven patients had oral involvement also; 6 had at least one recurrence; and 3 were hospitalized for pain control. Analgesics and topical corticosteroids were the most common treatments. Ulcerations resolved within several weeks in all patients. LIMITATIONS Retrospective study design, small study size, and 50% questionnaire response rate are limitations. CONCLUSIONS Although rare, RNSRAGU should be considered when genital ulceration follows an acute systemic illness.
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Affiliation(s)
- Julia S Lehman
- Division of Clinical Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Lai K, Lambert E, Mercurio MG. Aphthous vulvar ulcers in adolescent girls: case report and review of the literature. J Cutan Med Surg 2010; 14:33-7. [PMID: 20128989 DOI: 10.2310/7750.2009.08060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aphthous vulvar ulcers are painful ulcerations on the genital mucosa frequently accompanied by systemic symptoms. They are most commonly reported in young women and adolescents without a history of sexual contact. Diagnosis is made by exclusion of more common causes, and treatment for this self-limited condition is mainly symptomatic. OBJECTIVE Clinicians should be aware of this rare condition to avoid misdiagnoses and unwarranted investigations into sexual abuse or false accusations of sexual activity. METHODS We report a case of an 11-year-old girl with systemic symptoms and vulvar ulcers of unknown etiology. RESULTS The patient's illness was consistent with previous reports that vulvar ulcers can occur without sexual transmission or a documented infectious cause. CONCLUSION A lack of general knowledge regarding this entity may lead to its exclusion from the differential diagnosis of vulvar ulcers in this patient population. Aphthous ulcers should be strongly considered in any adolescent with vulvar ulcers.
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Affiliation(s)
- Kimberly Lai
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Zaidenberg-Israeli G, Assia A, Reif S, Grisaru-Soen G. It's not what you think: pain in the genital area was followed by ulceration. Am J Obstet Gynecol 2010; 202:205.e1-2. [PMID: 19766976 DOI: 10.1016/j.ajog.2009.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 03/01/2009] [Accepted: 07/16/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Galit Zaidenberg-Israeli
- Department of Pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Eyk NV, Allen L, Giesbrecht E, Jamieson MA, Kives S, Morris M, Ornstein M, Fleming N. Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 31:850-862. [PMID: 19941710 DOI: 10.1016/s1701-2163(16)34304-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vulvovaginal complaints in the prepubertal child are a common reason for referral to the health care provider. The Cochrane Library and Medline databases were searched for articles published in English from 1980 to December 2004 relating to vulvovaginal conditions in girls. The following search terms were used: vulvovaginitis, prepubertal, pediatric, lichen sclerosis, labial fusion, labial adhesion, genital ulcers, urethral prolapse, psoriasis, and straddle injuries. The objectives of this article are to review the normal vulvovaginal anatomy, describe how to perform an age-appropriate examination, and discuss common vulvovaginal disorders and their management in young girls.
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Affiliation(s)
- Nancy Van Eyk
- Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax NS
| | - Lisa Allen
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Ellen Giesbrecht
- Department of Obstetrics and Gynaecology, BC Women's Hospital, University of BC, Vancouver BC
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston ON
| | - Sari Kives
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Margaret Morris
- Department of Obstetrics and Gynecology, Health Sciences Centre, University of Manitoba, Winnipeg MB
| | - Melanie Ornstein
- Division of Paediatric Gynaecology, Hospital for Sick Children, University of Toronto, Toronto ON
| | - Nathalie Fleming
- Division of Pediatric and Adolescent Gynecology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa ON
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Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol 2009; 47:1358-63. [PMID: 19261782 DOI: 10.1128/jcm.01873-08] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Knowing the prevalence of potential etiologic agents of nongonococcal and nonchlamydial cervicitis is important for improving the efficacy of empirical treatments for this commonly encountered condition. We describe four multiplex PCRs (mPCRs), designated VDL05, VDL06, VDL07, and VDL09, which facilitate the detection of a wide range of agents either known to be or putatively associated with cervicitis, including cytomegalovirus (CMV), enterovirus (EV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), herpes simplex virus type 1 (HSV-1), and herpes simplex virus type 2 (HSV-2) (VDL05); Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma genitalium, and Mycoplasma hominis (VDL06); Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, and group B streptococci (VDL07); and adenovirus species A to E (VDL09). The mPCRs were used to test 233 cervical swabs from 175 women attending a sexual-health clinic in Sydney, Australia, during 2006 and 2007. The agents detected alone or in combination in all cervical swabs (percentage of total swabs) included CMV (6.0), EV (2.1), EBV (2.6), VZV (4.7), HSV-1 (2.6), HSV-2 (0.8), HSV-2 and VZV (0.4), U. parvum (57.0), U. urealyticum (6.1), M. genitalium (1.3), M. hominis (13.7), C. trachomatis (0.4), T. vaginalis (3.4), and group B streptococci (0.4). Adenovirus species A to E and T. pallidum were not detected. These assays are adaptable for routine diagnostic laboratories and provide an opportunity to measure the true prevalence of microorganisms potentially associated with cervicitis and other genital infections.
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Wetter DA, Bruce AJ, MacLaughlin KL, Rogers RS. Ulcus vulvae acutum in a 13-year-old girl after influenza A infection. Skinmed 2008; 7:95-8. [PMID: 18327008 DOI: 10.1111/j.1751-7125.2008.07273.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 13-year-old otherwise healthy premenarchal girl presented with acute onset of painful vulvar ulcerations. One day before developing vulvar ulcerations, she experienced flu-like symptoms, including a low-grade fever, cough, sore throat, and myalgia. Results of a throat swab were positive for influenza A infection (polymerase chain reaction [PCR] assay), and the patient was treated with oseltamivir. The patient's constitutional symptoms improved slightly, but within 2 days after her initial presentation, she returned to her primary care provider and described 24 hours of dysuria and vulvar swelling. She had a history of herpes labialis (cold sores) and rare episodes of minor oral aphthae (canker sores) that occurred less than twice a year. The patient denied a history of sexual activity, sexual abuse, or physical trauma. Physical examination showed ulceration and swelling of the labia minora, and the patient received an empiric dose of acyclovir (200 mg 4 times daily) for presumed autoinoculated herpes simplex virus (HSV) infection. An ulcer swab was performed, and urinalysis revealed no evidence of infection. Two days later, the patient presented to the emergency department with increasing vulvar pain and vaginal discharge. The previous ulcer swab findings were negative for HSV (PCR assay), and consequently, acyclovir was discontinued after 1 day of therapy. She received topical viscous lidocaine and an empiric dose of oral fluconazole. The lidocaine provided temporary symptomatic relief. Results of DNA amplification studies were negative for Chlamydia trachomatis and Neisseria gonorrhoeae. A potassium hydroxide preparation was negative for fungi, and an ulcer swab for bacterial culture revealed usual flora. Of note, the PCR assay for Epstein-Barr virus was not performed on ulcer cells. The patient was referred to the department of dermatology, and results of a physical examination showed copious white mucoid discharge and a 2-cm ulceration of the left labia minora (Figure, panel A). Two smaller pinpoint ulcerations and swelling of the left labia minora were also noted. The lesions were clinically indistinguishable from the genital aphthous ulcers of patients with complex aphthosis (recurrent, severe aphthous ulcers on oral or genital mucosa). A diagnosis of ulcus vulvae acutum was made, and treatment was started with clobetasol 0.05% ointment (4 times daily) and lidocaine gel as needed. Four days later, the patient reported marked symptomatic improvement. Physical examination showed near resolution of the large vulvar ulceration (Figure, panel B). The patient tapered use of clobetasol ointment over the next several days until the ulcerations healed completely. Two months after her initial episode, the patient again had 3 small vulvar erosions after symptoms that included low-grade fever, malaise, and vomiting. She did not receive oseltamivir for this illness; clobetasol ointment was applied 4 times daily, and the vulvar erosions ameliorated within a few days. Her constitutional symptoms resolved without treatment. The patient has not experienced any further episodes of vulvar ulcerations in the 18 months after the most recent treatment.
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Affiliation(s)
- David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Hernández-Núñez A, Córdoba S, Romero-Maté A, Miñano R, Sanz T, Borbujo J. Lipschütz [corrected] ulcers--four cases. Pediatr Dermatol 2008; 25:364-7. [PMID: 18577045 DOI: 10.1111/j.1525-1470.2008.00684.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A distinctive clinical entity of acute genital ulcers occurring in adolescents, with nonvenereal infectious etiology was described by Lipschütz in 1913. We describe four puberal virgin girls who developed fever and painful genital ulcers. The main causes infectious and noninfectious of ulceration were rejected. Although the etiology is unknown, recent cases related with Epstein-Barr virus acute infection have been reported.
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Kos L, Galbraith SS, Lyon VB. Vaginal ulcerations with acute mycoplasma infection. J Am Acad Dermatol 2007; 56:S117-8. [PMID: 17434036 DOI: 10.1016/j.jaad.2006.05.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 05/24/2006] [Accepted: 05/26/2006] [Indexed: 11/29/2022]
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Barnes CJ, Alió AB, Cunningham BB, Friedlander SF. Epstein-Barr virus-associated genital ulcers: an under-recognized disorder. Pediatr Dermatol 2007; 24:130-4. [PMID: 17461807 DOI: 10.1111/j.1525-1470.2007.00358.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infectious mononucleosis is the best-known syndrome associated with primary Epstein-Barr virus infection. Although a variety of cutaneous and mucosal manifestations are recognized in infectious mononucleosis, genital ulcers have only rarely been described. We describe an otherwise healthy 14-year-old girl in whom painful genital ulcers developed during an episode of serologically-confirmed primary Epstein-Barr virus infection. Clinical, serologic, and histopathologic evaluation failed to disclose evidence of any other etiologic explanation for her lesions. The patient remains well, without recurrence. To date, only 13 instances of genital ulceration in females attributable to Epstein-Barr virus infection have been reported.
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Affiliation(s)
- Cheryl J Barnes
- Division of Pediatric and Adolescent Dermatology, Children's Hospital, San Diego, University of California, San Diego Medical School, San Diego, California, USA
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35
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Baron Joly S, Berville Levy S, Bougnoux M, Chevallier B, Saiag P, Moyal Barracco M. P241 - Ulcères aigus de la vulve : la toxoplasmose, aussi ? Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79970-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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36
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P271 - Ulcère aigu de la vulve : formes cliniques et étiologies (6 cas). Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)80000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nicolas X, Ansart S, Jaffuel S, Deluc A, Le Berre R, Tandé D, Garré M, Pennec YL. [Genital ulcerations due to Epstein-Barr virus primary infection]. Rev Med Interne 2005; 26:913-6. [PMID: 16129521 DOI: 10.1016/j.revmed.2005.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 07/12/2005] [Indexed: 11/24/2022]
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