To keep in scope: vulvar aphthous ulcers after COVID-19 vaccination

Abstract

Background: Vulvar ulcers are a rare finding in females who are not sexually active. Aphthous ulcers may arise from an excessive immune response to an infectious agent or physiologic stress in a predisposed patient. They are associated with severe local pain, discomfort, and in some cases systemic symptoms. The diagnostic and treatment approach for this entity may inflict significant distress and anxiety on both the patient and her family. We aim to add to the existing literature by describing two cases of acute vulvar ulcers arising in non-sexually active adolescents after completing Pfizer-BioNTech COVID-19 vaccination schedule (2 doses). Case: Two 16-year old Hispanic high school students arrived for evaluation at a Pediatric and Adolescent Gynecology focused practice in Mexico. Both denied sexual activity and had unremarkable personal and family medical histories. At the time of the encounter, their vital signs were in normal ranges. Patients' clinical characteristics are depicted in table 1. Both patients received supportive treatment with a cream containing zinc oxide as barrier protection, xylocaine 2% ointment for pain management (PRN), and were educated in general vulvar hygiene recommendations. Patient A endorsed significant symptom improvement after 3 days and had no evidence of lesions after 10 days. Patient B endorsed significant symptom improvement 1 day after the visit and had no evidence of lesions after 10 days. Comments: These cases illustrate the plausible association between COVID-19 vaccination and vulvar aphthous ulcers. We must include this diagnosis among our differentials when facing such cases. https://www.abstractscorecard.com/uploads/Tasks/upload/15942/ZDJDEDZO-1123181-1-ANY(1).docx