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Reina J, Iturbe A. [Detection of Epstein-Barr virus in female genital ulcers]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:365-366. [PMID: 38770625 PMCID: PMC11231486 DOI: 10.37201/req/005.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Affiliation(s)
- J Reina
- Jordi Reina,Unidad de Virología. Servicio de Microbiología. Hospital Universitario Son Espases. Carretera de Vallmedossa 79. 07120 Palma de Mallorca. Spain.
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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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Abstract
OBJECTIVE We aimed to describe our experience in diagnosing and managing Lipschutz ulcers in children. METHODS This was a retrospective data review in a tertiary referral clinic for pediatric and adolescent gynecology. We identified patients referred with a vulval ulcer and recorded relating symptoms, presentation, and resolution. RESULTS We identified 7 nonsexually active girls with vulvar ulcers presenting within the course of an upper respiratory infection, including fever and cough. Average age was 12.25 years (range, 11-14.5 years). All patients presented with at least one large painful ulcer within the inner surface of the labium minor, of up to 2 cm in diameter.Initial presentation was of a bullous lesion that was then ulcerated, covered by a black gangrenous scab. Over the course of the week, the scab fell leaving a white-based ulcer that gradually healed. All children complained of dysuria stemming from contact irritation with urine. The ulcer gradually disappeared, leaving no mark within 10 days of initial presentation.Two of 7 patients presented with 3 similar recurrences after flu-like symptoms.None of the patients qualified for diagnosis of Behcet disease. CONCLUSIONS Lipschutz ulcers are painful genital lesions causing anxiety to the girl and her family. Pediatricians and gynecologists should be aware of the condition, diagnose it where appropriate, avoid unnecessary medication, and reassure the patient that it is self-limited.
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Affiliation(s)
- Maria Charamanta
- From the 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra Hospital
| | - Alexandra Soldatou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens, Aglaia and Panagiotis Kyriakou Hospital, Athens, Greece
| | - Lina Michala
- From the 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra Hospital
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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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Maliyar K, Mufti A, Syed M, Selk A, Dutil M, Bunce PE, Alavi A. Genital Ulcer Disease: A Review of Pathogenesis and Clinical Features. J Cutan Med Surg 2019; 23:624-634. [PMID: 31253050 DOI: 10.1177/1203475419858955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Genital ulcer disease can be caused by a wide variety of sources. Most commonly, genital ulcer disease is grouped into infectious and noninfectious causes. HSV, syphilis, lymphogranuloma venereum, and chancroid represent some common infectious ulcers. Noninfectious causes on the other hand can be inflammatory, noninflammatory, or malignant (eg, squamous cell carcinoma). Depending on the etiology, genital ulcers may present with unique features that can help clinicians identify the etiology and start treatment in a timely manner. The clinical presentation and management of infectious and noninfectious genital ulcers will be discussed in this review.
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Affiliation(s)
| | | | - Maleeha Syed
- Faculty of Medicine, University of Ottawa, ON, Canada
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, University of Toronto, ON, Canada
| | - Maha Dutil
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Paul E Bunce
- Division of Infectious Diseases, Department of Medicine, University of Toronto, ON, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada
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Nonsexually Transmitted Genital Ulcer Secondary to Hand, Foot, and Mouth Disease. Obstet Gynecol 2019; 133:1269-1273. [PMID: 31135744 DOI: 10.1097/aog.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genital ulcers that are not the result of sexually transmitted infections (STIs) are uncommon, and case reports predominantly feature pubertal girls. CASE A 38-year-old monogamous, nulliparous woman acutely developed painful vaginal ulcers 7 days after babysitting a child who was subsequently diagnosed with hand, foot, and mouth disease. The patient developed nonspecific systemic symptoms followed by painful and rapidly expanding genital ulcers. Laboratory test results for herpes, syphilis, human immunodeficiency virus, gonorrhea, chlamydia, and Epstein-Barr virus were all negative. The patient was treated with brief inpatient observation, oral prednisone, meticulous wound care, and debridement. The ulcers resolved over a 3-week period. CONCLUSION Although typically associated with pubertal girls, genital ulcers that are not the result of STIs can affect adults as well. The cornerstone of management regardless of age is supportive care, debridement and wound care, and treatment with steroids.
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Chen W, Plewig G. Lipschütz genital ulcer revisited: is juvenile gangrenous vasculitis of the scrotum the male counterpart? J Eur Acad Dermatol Venereol 2019; 33:1660-1666. [DOI: 10.1111/jdv.15598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
Affiliation(s)
- W. Chen
- Department of Dermatology and Allergy Technische Universität München Munich Germany
- IZZ Immunologie‐Zentrum Zürich Zurich Switzerland
| | - G. Plewig
- Department of Dermatology and Allergy Ludwig‐Maximilian‐University of Munich Munich Germany
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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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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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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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Rahhal H, Nunes JT, Lopes LDC, Prokopowitsch AS. Simultaneous genital ulcer and meningitis: a case of EBV infection. AUTOPSY AND CASE REPORTS 2016; 6:45-9. [PMID: 27547743 PMCID: PMC4982784 DOI: 10.4322/acr.2016.033] [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: 08/18/2015] [Accepted: 03/14/2016] [Indexed: 12/05/2022] Open
Abstract
The Epstein-Barr virus (EBV) is associated with a broad spectrum of diseases, mainly because of its genomic characteristics, which result in different latency patterns in immune cells and infective mechanisms. The patient described in this report is a previously healthy young man who presented to the emergency department with clinical features consistent with meningitis and genital ulcers, which raised concern that the herpes simplex virus was the causative agent. However, the polymerase chain reaction of cerebral spinal fluid was positive for EBV. The authors highlight the importance of this infection among the differential diagnosis of central nervous system involvement and genital ulceration.
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Affiliation(s)
- Hassan Rahhal
- Internal Medicine Department - Hospital das Clínicas - Universidade de São Paulo - São Paulo/SP - Brazil
| | - Jairo Tavares Nunes
- Internal Medicine Department - Hospital das Clínicas - Universidade de São Paulo - São Paulo/SP - Brazil
| | - Leonardo da Costa Lopes
- Internal Medicine Division - Hospital Universitário - Universidade de São Paulo - São Paulo/SP - Brazil
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García JG, Pavón BM, Martín LM, Martínez BF, Norniella CM, Caro FÁ. Lipschütz ulcer:: A cause of misdiagnosis when suspecting child abuse. Am J Emerg Med 2015; 34:1326.e1-2. [PMID: 26782798 DOI: 10.1016/j.ajem.2015.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022] Open
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Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A. Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection. Eur J Pediatr 2013; 172:1121-3. [PMID: 23636284 DOI: 10.1007/s00431-013-2013-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/17/2013] [Indexed: 12/01/2022]
Abstract
Lipschütz ulcer is an uncommon entity that is clinically characterised by a flu-like syndrome accompanied by an acute painful necrotic vulvar ulcer. It typically occurs in young women with no sexual contact history, and it is very rare among children. The aetiology is unknown, although recently several reports have related Epstein-Barr virus primary infection with this entity. We report a 17-month-old girl with fever and an acute genital ulcer. All the complementary tests for the most frequent causes of vulvar ulcers yielded negative results, whereas viral serology and polymerase chain reaction technique confirmed the presence of an acute Epstein-Barr virus infection. When main causes of genital ulcer have been excluded, and there is no history of sexual contact, Lipschütz ulcer should be included in the differential diagnosis. Detection of Epstein-Barr virus genome by polymerase chain reaction can lead to an earlier diagnosis.
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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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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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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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Abstract
The diagnosis and management of the following non-infectious vulvar ulcers are reviewed: vulvar aphthae in adult and pediatric patients, aphthae associated with Behçet's disease, vulvar ulcers resulting from Crohn's disease, and vulvar ulcers associated with human immunodeficiency virus infection. There are many resources providing excellent reviews of infectious ulcers; therefore this topic will not be covered here.
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Alés-Fernández M, Rodríguez-Pichardo A, García-Bravo B, Ferrándiz-Pulido L, Camacho-Martínez FM. Three cases of Lipschutz vulval ulceration. Int J STD AIDS 2010; 21:375-6. [PMID: 20498113 DOI: 10.1258/ijsa.2010.010044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.
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Affiliation(s)
- M Alés-Fernández
- Department of Dermatology, Virgen Macarena University Hospital, 41009 Seville, Spain.
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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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Muñoz Saá L, Martínez Rodríguez A, Villanueva Asensio L, Sánchez Gabaldón R, Rivas Barrera C, Gómez Laencina A. Úlcera de Lipschütz. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Martín JM, Godoy R, Calduch L, Villalon G, Jordá E. Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection. Pediatr Dermatol 2008; 25:113-5. [PMID: 18304169 DOI: 10.1111/j.1525-1470.2007.00597.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A previously healthy 16-year-old girl presented with painful acute genital ulcers that appeared in the context of a primary cytomegalovirus infection. Complementary examinations ruled out both venereal disease and other usual causes of genital ulcerations, and the lesions resolved in < 2 weeks with no sequelae or later recurrences. Cytomegalovirus disease should be considered in the screening of acute vulval ulcers.
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Affiliation(s)
- José M Martín
- Department of Dermatology, Hospital Clinico Universitario, Valencia, Spain.
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Lawee D. Mild infectious mononucleosis presenting with transient mixed liver disease: case report with a literature review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2007; 53:1314-6. [PMID: 17872846 PMCID: PMC1949255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- David Lawee
- Department of Family and Community Medicine at the University of Toronto in Ontario.
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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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Morgan DJ, Steele EK, McFaul P. 'All that ulcerates is not herpes simplex'. J OBSTET GYNAECOL 2006; 26:703-4. [PMID: 17071452 DOI: 10.1080/01443610600940307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D J Morgan
- Department of Gynaecology, Belfast City Hospital, Lisburn Road, Belfast, UK.
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Abstract
STI are among the most common pathological conditions affecting sexually active adolescents. Both screening of asymptomatic adolescents and a thoughtful, thorough approach to the evaluation of symptoms are critical measures in STI identification and control.
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Affiliation(s)
- Cynthia Holland-Hall
- Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Children's Hospital, 700 Children's Drive, Columbus, 43205, USA.
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30
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Huppert JS, Gerber MA, Deitch HR, Mortensen JE, Staat MA, Adams Hillard PJ. Vulvar ulcers in young females: a manifestation of aphthosis. J Pediatr Adolesc Gynecol 2006; 19:195-204. [PMID: 16731413 DOI: 10.1016/j.jpag.2006.02.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To examine the etiology, clinical course, and outcomes of non-sexually transmitted vulvar ulcers in young females. DESIGN A prospective cohort study of subjects referred to a tertiary center who had active vulvar ulcers and no evidence of sexually transmitted infections were evaluated with a structured clinical and laboratory protocol and followed with visits or telephone calls. RESULTS Twenty eligible subjects had a mean age of 14 years (range 10-19), and five were premenarchal. Nineteen reported systemic symptoms such as fever, malaise, and headache. Most ulcers were >1cm in diameter (range 0.3-5 cm) and were located on the medial aspect of the labia minora. All viral, bacterial, and fungal cultures were negative. Serologic testing for Epstein-Barr virus (EBV) infection demonstrated 10 subjects with evidence of prior infection, two with acute infection, one indeterminate, and seven negative for infection. Two subjects had evidence of possible acute cytomegalovirus (CMV) infection. Other laboratory findings were nonspecific. The median duration of pain was 10 days (range 6-30), and 75% healed by 21 days. Follow up was available for 19 subjects (median 14 months). Seven experienced recurrent ulcers 2-16 months after the initial episode, and 10 had experienced oral aphthous ulcers. None met criteria for other etiologies of vulvar ulcers reported in the literature. CONCLUSIONS No single infectious agent was identified as a cause of vulvar ulcers. Most cases were not temporally associated with either acute EBV or CMV infection. These ulcers are consistent with aphthous major or complex aphthosis that arise in response to acute illness.
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Affiliation(s)
- Jill S Huppert
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Abstract
Currently there are eight human herpesviruses identified that cause disease in both adults and children. Although the manifestations of disease differ with each herpesvirus, cutaneous presentations are common among almost all of them. These skin manifestations may be visually similar among several of these viruses, occasionally making it challenging to diagnose the patient's illness. Laboratory diagnostic testing is commercially available for most of these viruses. Because many herpesvirus infections are self-limiting in immunocompetent hosts, patients require only supportive care. Effective antiviral therapy is available for the more severe cases of infection caused by herpes simplex virus (HSV), varicella zoster virus (VZV), or cytomegalovirus (CMV). Healthcare practitioners should become familiar with the different cutaneous manifestations these viruses may exhibit.
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Affiliation(s)
- John F Toney
- Division of Infectious and Tropical Medicine, Department of Internal Medicine, University of South Florida College of Medicine, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
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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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Abstract
In North America, the most common cause of vulvar ulcers is infection with herpes simplex virus. However, Epstein-Barr virus can also cause vulvar ulcers, and may be underrecognized. Unlike herpes simplex virus, Epstein-Barr virus is not necessarily sexually transmitted. Therefore, it is particularly important to include in the differential diagnosis of genital ulcers for patients for whom a diagnosis of a venereal infection has important psychosocial consequences. We report three cases of acute primary Epstein-Barr virus infection in which the presenting symptoms were vulvar ulceration.
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Affiliation(s)
- Sola X Cheng
- Department of Medicine, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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Svedman C, Holst R, Johnsson A. Ulcus vulvae acutum, a rare diagnosis to keep in mind. Eur J Obstet Gynecol Reprod Biol 2004; 115:104-5. [PMID: 15223176 DOI: 10.1016/j.ejogrb.2003.09.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2002] [Revised: 07/02/2003] [Accepted: 09/10/2003] [Indexed: 11/25/2022]
Abstract
Genital ulceration is today often thought to be caused by herpes simplex. In this case report, a rare differential diagnosis, ulcus vulvae acutum is described, probably caused by Epstein-Barr virus (EB-virus).
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Affiliation(s)
- C Svedman
- Department of Dermatology and Venereology UMAS, Malmo, Sweden.
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Affiliation(s)
- Cynthia Holland-Hall
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine and Public Health, Columbus, Ohio 43210, USA
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Abstract
Vulvar ulceration can occur as the primary or secondary event in a large variety of conditions. These include infections, autoimmune and/or inflammatory diseases and dermatoses, neoplasias, and conditions with an unknown etiology. A thorough medical history and careful patient examination remain the linchpin of management. Specific microbiological, histological, immunological, and other investigations are often necessary to establish or confirm a diagnosis, but the relevant importance of these will vary in the individual patient. The specific management of each patient will also vary accordingly. Other important factors which will influence the frequency with which any physician will make one of the specific diagnoses include practice location, referral mechanisms, and population demographics. This chapter is written with the generalist dermatologist in mind. Whilst dermatoses are given prime attention, important infections and other conditions are also dealt with. The ultimate aim of the present paper is to provide the generalist dermatologist with a useful tool for the diagnosis and management of a patient that present's with a vulvar ulcer(s).
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