Abstract
ABSTRACTAcute vulvar ulcer (Lipschütz’s ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet’s syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz’s ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.
Highlights
Lipschütz’s ulcers, ulcus vulvae acutum, are a non-sexually acquired condition, characterized by the sudden onset of painful and necrotic genital ulcers
Two cases associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in the literature.[3,4] We report a case of a woman with acute vulvar ulcer possibly associated with SARS-CoV-2
We report a case of a woman with COVID-19 with sudden, painful, necrotic ulcers, which resolved in few days, which was characteristic of a Lipschütz’s ulcers[2] associated with SARS-CoV-2 as the possible trigger of this condition
Summary
Cláudia Márcia de Azevedo Jacyntho, Marcela Ignacchiti Lacerda, Mariana de Sousa Ribeiro de Carvalho, Maria Roberta Meneguetti Seravali Ramos, Pedro Vieira-Baptista, Sandra Helena de Azevedo Durães Bandeira. Acute vulvar ulcer (Lipschütz’s ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. Selfresolution without scarring is the usual course, and the Lipschütz’s ulcers may be triggered by Epstein-Barr virus (EBV), cytomegalovirus (CMV), Mycoplasma pneumoniae and Toxoplasma gondii.[1] The diagnosis is of exclusion after ruling out Sexually Transmitted Infections (STIs), idiopathic aphthosis, Behçet’s disease, and extra-genital Crohn’s disease.[2]. The woman had significant improvement of the lesions (Figure 2), as well as pain reduction and complete remission of headache and myalgia At this time, the SARS-CoV-2 RT-PCR (nasopharyngeal) test was negative and D-dimer levels were normal (430mcg/L). This study was approved by the Ethics Committee of Hospital Federal Cardoso Fontes (approval number: 4,310,153, CAAE: 38673320.3.0000.8066)
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