Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature

Abstract

Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.