Acute Vulvar Aphthous (Lipschütz) Ulcer After COVID-19 Vaccine: Two Cases [ID: 1337743

Abstract

INTRODUCTION: Vulvar aphthous ulcers are uncommon, non-sexually transmitted genital lesions that typically arise in adolescents and young women after viral infection. The pathogenesis of this condition is poorly understood but is thought to arise from an immune-mediated process. More recently, there have been several reports of vulvar aphthosis after COVID-19 infection, and to date, we have identified five case reports describing the development of this condition within days of receiving one of the existing U.S. Food and Drug Administration-approved mRNA COVID-19 vaccines. METHODS: We present the cases of two adolescents, aged 13 and 16 years, who both developed acute genital aphthous ulcers within days of their second Pfizer-BioNTech COVID-19 vaccinations with no other apparent triggers. CONCLUSION: These two cases represent a growing number of patients who have developed acute genital ulceration (AGU) in close temporal proximity to COVID-19 vaccination, which represents a potential novel etiology for this uncommon condition. If vaccination is indeed a trigger for AGU, this may support an immune-mediated pathogenesis, although future studies are needed to explore this further. The continued publication of high-quality case reports describing AGU will allow us to gather enough data to make statistical inferences and to raise awareness for this condition, which is underrecognized and often misdiagnosed by providers.