Acute Genital Ulcers Research Articles

COVID 19 vaccination as a trigger of acute genital ulcers in an immunocompromised adolescent—case study and literature review

Acute genital ulcers can affect females of all ages. In children, they often appear as an emergency and remain a diagnostic challenge for pediatricians, gynecologists and dermatologists. Prompt diagnosis and identification of disease- related factors help to implement appropriate treatment. Firstly, it is crucial to properly compile the past medical history of the patient. Past infectious, autoimmune, malignant or traumatic conditions, as well as vaccinations may contribute to the occurrence of acute genital ulcers. Moreover, new infectious agents, such as severe acute respiratory syndrome coronavirus 2 and vaccinations against Coronavirus disease of 2019, may play a significant role in the development of atypical clinical symptoms. Here we present a case of a 12-year-old girl with acute genital ulcers. Additional symptoms accompanying the ulcer included: abdominal pain, nausea, vomiting, dysuria, vulvar pain and fever. Blood test showed leukocytosis, especially neutrophilia and monocytosis and increased levels of c-reactive protein and procalcitonin. Serological tests for the most common infections were negative. Moreover, the patient had a history of autoimmune diseases. She had periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, and IgA vasculitis, also known as Henoch-Schönlein purpura in her past medical history. Additionally, she was vaccinated against SARS-CoV-2 shortly before the lesions appeared.

Lipschutz ulcers – acute genital ulceration in a 17-year-old: A case report

Background: The diagnosis of genital ulcers remains a challenge. Lipschutz ulcers are rare, painful, necrotic, and underdiagnosed lesions that are often found in nonsexually active adolescent females. The onset is acute and follows the prodromal phase of viral illness. Pathogenesis is unclear, but a hypersensitivity reaction to viral or bacterial infection leads to the deposition of an immune complex in the dermal vessels. The disease is self-limiting over two to six weeks. 
 Case presentation: A 17-year-old female presented to the Emergency Department at the Royal Children’s Hospital, Melbourne with painful genital ulcers for five days and acute urinary retention for two days. This was preceded by a flu-like illness a week prior with associated body heat and polyarthralgia. The patient denied any history of sexual activity. There was no relevant medical history, no use of regular medication, and no history of trauma or sexual abuse. Perineal examination revealed “kissing” vulval lesions, 1 cm each, on the lower aspect of the labia majora. The lesions were symmetric with an erythematous border and a necrotic base. Sexually transmitted illness screening and her autoimmune profile were negative. Epstein-Barr virus IgG was positive and inflammatory markers were mildly elevated. Genital culture reported mixed anaerobes. The patient was catheterized, and administered local and systemic analgesia, steroid cream, and oral antibiotics. Wound care was instituted three times a day. She was discharged home after five days to complete medication once she was pain-free and able to pass urine.
 Conclusion: The diagnosis of Lipschutz ulcer is an exclusion and other causes of genital ulceration such as genital herpes, sexually transmitted infections, and autoimmune diseases must first be ruled out. Healing without scarring is spontaneous, and management involves wound care, local and systemic analgesia, local corticosteroids, and antibiotics if there is evidence of secondary infection.

Lipschütz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room.

Primary acute genital ulcers, or Lipschütz ulcers (LU), are nonsexually transmitted, painful, self-limiting, nonrecurrent vulvar ulcers with unclear pathogenesis, representing a challenging diagnosis in emergency setting. LU have recently been described in association with severe acute respiratory syndrome coronaVirus 2 (SARS-CoV-2) infection and vaccination. The aim of this study is to describe 2 cases of LU due to SARS-CoV-2 infection, highlighting the diagnostic process, differential diagnosis, disease course, and management options. We describe 2 young females (12 and 9 years old) who presented to pediatric emergency room with the sudden onset of well-demarcated, painful, vulvar ulcers with fibrinous necrotic center. Both patients tested positive to SARS-CoV-2 nasal swab, and, at physical examination, no other lesions were found in other cutaneous or mucosal sites. Sexual abuse was excluded in both cases, as well as infectious and autoimmune diseases. Supportive analgesic therapy was administered, and complete remission of lesions was observed at follow-up visits without evidence of scarring. The main limitation of this work is represented by the small number of cases described. Even though extremely rare, LU related to COVID-19 are an emerging entity to be considered in the diagnosis of acute genital ulcerations. Multidisciplinary diagnostic workup of genital ulcers must be established in order to exclude sexual child abuse, to ensure patient safety, and to avoid unnecessary treatment and familial anxiety.

C1 (Clinical Case) Case Presentation: Acute Genital Ulceration in a 15-Year-Old Girl

Abstract Introduction/Background Genital ulceration may occur in various conditions, and requires a systematic approach to its diagnosis. This should include consideration of both infectious and non-infectious etiologies. The most common causes of genital ulceration are herpes simplex virus (HSV) types 1 and 2 and syphilis (Treponema pallidum). Genital HSV may be asymptomatic or painful, and may present with inguinal lymphadenopathy, and fever. Primary syphilis may escape recognition as it presents with a single, painless, well-demarcated “chancre” that heals spontaneously in 3-6 weeks. Non-infectious etiologies of genital ulceration can include cutaneous drug reactions, and mechanical or chemical trauma. Granulomatous genital inflammation can be an extra-intestinal manifestation of Crohn’s disease characterized by pathognomonic “knife-cut” vulvar ulcers. This report presents a case of Lipschütz’s ulceration, or reactive non-sexually-acquired genital ulceration, as an under-recognized cause of genital ulcers in children. Case Description A previously healthy 15-year-old female presented to the emergency department with six days of daily fevers, and 72 hours of non-bloody diarrhea that had self-resolved. In addition, she complained of nausea and a headache. Notably, in the last day, she had developed labial swelling, perianal pruritus, and vaginal burning. On history, her last menstrual period was one week ago, and she was not sexually active. It was noted that she had consumed Kinder-SurpriseTM eggs in the last week, which had been recently recalled for Salmonella contamination. Pelvic exam initially showed multiple hemorrhagic vesicles involving the labia minora (Fig. 1A). On day one of admission, she developed two symmetric, well-delimited ulcers at the 5 o’clock and 7 o’clock positions on the labia minora, each 12 mm x 5 mm in size (Fig. 1B). By the second day of admission, she had dysuria requiring catheterizing. HSV, chlamydia and gonorrhea were not detected on vaginal swabs, and serologic testing for syphilis was negative. Salmonella montevideo was detected on her blood cultures and she was started on intravenous antibiotics. Her vulvar ulcers improved with a conservative regimen of local hygiene, wound care, and pain control. The final diagnosis was of Lipschütz’s ulceration (LU). Discussion LU is characterized by the sudden onset of necrotic and painful genital ulcers, and typically occurs in young (< 20 years old), sexually inactive females who have no history of genital ulcers, and were not previously affected by a chronic inflammatory condition. In LU, there are usually 1-3 lesions that are large (>10 mm), shallow and well-delimited. These tend to occur on the medial aspects of the labia minora and vestibule and have a symmetric “kissing” distribution on opposing surfaces. Voiding disorders, aphthous ulcers and enlarged inguinal lymph nodes have also been reported in LU. The pathophysiology of LU is not well understood. It often occurs concomitantly with an infectious disease and develops before its resolution. LU is most associated with Epstein-Barr virus, but has also been described with cytomegalovirus, mycoplasma species, Toxoplasma gondii, and influenza A and B. LU is self-limited and generally resolves without recurrence or long-term sequelae within 3 weeks. For analgesia, topical lidocaine is recommended, especially 5-10 minutes before micturition. Sitz baths, application of a bland barrier cream prior to and after voiding, avoidance of pads and underwear, and maintenance of good hydration to minimize irritation by concentrated urine also constitute important components of supportive care for LU. Conclusion Lipschütz’s ulcers are poorly understood and therefore under-diagnosed, or mis-diagnosed as herpes simplex infection, in which case they are treated with acyclovir without benefit. Identification of an etiologic trigger, such as a viral or bacterial infection, can aid in their appropriate detection. To date, there is one other reported case of LU associated with salmonella. This case report aims to describe LU as an uncommon but important entity in the paediatric population. Images

Acute genitale ulcera en Lipschütz-ulcus: differentiaaldiagnose en behandeling

Acute genital ulcerations and Lipschütz ulcus: differential diagnosis and treatment Lipschütz ulcus is a rare cause of acute genital ulceration. It mostly occurs in female patients of adolescent age and even in young children. In contrast to some of the more frequent causes of genital ulcerations, it is non-sexually related. It presumably occurs as a reaction to a non-genital infection and may thus also occur in virgins. It is mostly associated with an Epstein-Barr virus infection, but other pathogens such as influenza or the coronavirus can also cause this kind of reaction. When a patient presents with acute genital ulcerations, Lipschütz ulcus should be considered in the differential diagnosis. It is a diagnosis by exclusion since no specific diagnostic test is available. In order to distinguish between the different causes of genital ulcerations, it is important to perform a thorough sexual anamnesis, to be alert for possible signs of sexual abuse, to ask the patient about recent flu-like symptoms and to screen for the presence of extragenital lesions. It is a self-limiting condition. The lesions heal spontaneously after a couple of weeks. The treatment is supportive, consisting of analgesia and the prevention of secondary complications such as a bacterial superinfection, urinary retention due to dysuria or scarring. In severe cases with extensive lesions and/or insufficient pain control by other means, a treatment with corticosteroids may be considered, preferably topically.

Severe Acute Genital Ulcer: An Unusual Presentation of Behçet’s Disease: A Case Report

Introduction: Genital ulcers are among the main manifestations of Behçet’s disease (BD); however, large severe acute genital ulcers are not common. Case Presentation: A 29-year-old unmarried woman with a history of recurrent oral aphthae presented with a genital ulcer developed 2 weeks before admission. On clinical examination, there were two large painful ulcerations on the right labia majora, painful oral ulcerations, non-follicular pustules on the face and limbs, and painful edema on the left leg with positive Homan’s sign. The D-dimer level was elevated, and a Doppler ultrasound showed deep venous thrombosis of the right common femoral, femoral, and popliteal veins. The BD was diagnosed according to the International Criteria for Behçet’s Disease. The patient was treated with prednisone 40 mg/day and colchicine 1 mg/day, and the lesions developed well and healed within 2 weeks, leaving scarring lesions in the genital area. Conclusions: Behçet's disease is an important nonvenereal cause of genital ulceration. A high index of suspicion in a patient with mucocutaneous lesions might result in the early diagnosis, management, and prevention of complications.

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

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.

Management of Acute Genital Ulcers: A Survey of North American Pediatric and Adolescent Gynecology Care Providers

IntroductionAcute genital ulcers are painful ulcerations of the lower vagina and vulva, with limited data to guide management. We aimed to survey care providers to understand the workup and management of acute genital ulcers across North America. MethodsA cross-sectional survey was distributed to members of NASPAG. Data are presented descriptively, and management practices between care providers are compared using Fisher's exact test. ResultsResponses from 100 NASPAG members were included. Common diagnostic tests performed were herpes simplex virus PCR (82%), Epstein-Barr virus serology (56%), and cytomegalovirus serology (47%). Topical steroids were considered by 67% on the basis of the degree of accompanying inflammation. There was no difference in corticosteroid prescriptions according to the type or location of providers (P > .05). DiscussionCollaboration between pediatric and adolescent gynecology care providers is needed to prospectively evaluate the effectiveness of treatment modalities and develop evidence-based guidelines.

14. Management of acute genital ulcers; retrospective review of a tertiary Canadian centre and survey of North American Pediatric and Adolescent Gynecology care providers

14. Management of acute genital ulcers; retrospective review of a tertiary Canadian centre and survey of North American Pediatric and Adolescent Gynecology care providers

BehçetÓ?s disease as a differential diagnosis of acute genital ulcer: a case report

BehçetÓ?s disease as a differential diagnosis of acute genital ulcer: a case report

Lipschutz Ulcers in an Adolescent After Sars-CoV-2 Infection

This case report describes a 15-year-old female who presented with acute onset of painful genital ulcers. She denied being sexually active and tested positive for severe acute respiratory coronavirus 2 five days prior. Associated symptoms on days 1 to 3 included fatigue, nausea, headaches, and fever. Lipschutz ulcers (LUs), also known as aphthous ulcers, acute genital ulcers, and acquired genital ulcerations; are an uncommon, self-limiting, nonsexually transmitted condition characterized by the rapid onset of painful, necrotic ulcerations of the vulva or lower vagina. The pathogenesis of LUs is unclear, and the diagnosis is one of exclusion.

Nonpruritic hypopigmented macules on an immunocompromised patient

Nonpruritic hypopigmented macules on an immunocompromised patient

Acute genital ulcers in a young girl: a clinical challenge: Lipschütz ulcer

Acute genital ulcers in a young girl: a clinical challenge: Lipschütz ulcer

Úlcera genital aguda em adolescente: caso clínico

Acute genital ulcer, also known as Lipschütz ulcer, is an uncommon, non-sexually transmitted condition characterized by the rapid onset of a necrotic and painful ulcer in the vulvar region. It occurs in adolescents and young women, with or without sexual activity. It may be preceded by influenza-like or mononucleosis-like symptoms. Acute genital ulcers have been associated with Epstein-Barr virus (EBV) infection or other viral or bacterial infections. However, in most cases, the cause is not determined. We report the clinical case of an 11-year-old girl without previous vaginal or oral ulceration without sexual contact who sought medical assistance with a rapidly progressive vulvar ulcer wich had started six days before, preceded by episodic low fever. The exclusion of infectious causes, the spontaneous healing of the lesion and the indeterminate serology for Epstein-Barr led to the diagnosis of ulcer of Lipschütz.

Lipschutz ulcer – Nonsexual acute genital ulceration in a 10-year-old girl

Acute genital ulcers are painful and distressing. Lipschutz ulcer (LU), also known as ulcus vulvae acutum, is a rare and underdiagnosed entity presenting as an acute painful vulvar ulcer in young women. Although the etiology is not known, recent reports have associated it with infections such as Epstein–Barr virus, cytomegalovirus (CMV), Mycoplasma pneumoniae, Mycoplasma fermentans, mumps, and parvovirus B19. The diagnosis is made by exclusion, after ruling out the usual causes of genital ulcerations such as sexually transmitted diseases, autoimmune causes, trauma, drug reactions, and local manifestations of systemic illnesses. We report the case of a 10-year-old girl who developed flu-like symptoms, followed by painful vulvar ulcers within 2 days. Lipshutz ulcer must br considered among the causes of genital ulcers.

Toxigenic Corynebacterium diphtheriae-Associated Genital Ulceration.

In October 2016, an adolescent boy sought care for acute genital ulceration in Cologne, Germany. We presumed a sexually transmitted infection, but initial diagnostic procedures yielded negative results. He was hospitalized because swab samples from the lesion grew toxigenic Corynebacterium diphtheriae, leading to the diagnosis of possibly sexually transmitted cutaneous diphtheria.

Ulcus vulvae acutum Lipschütz: a systematic literature review and a diagnostic and therapeutic algorithm.

The case report literature on ulcus vulvae acutum Lipschütz (UVAL) is scant, and specific guidelines on its diagnosis and treatment are lacking. Our study's aim was to perform a systematic literature review of UVAL in order to formulate a diagnostic and therapeutic algorithm. Using the PRISMA criteria, we searched PubMed and MEDLINE for the terms ‘ulcus vulvae acutum’, ‘Lipschütz ulcer’ and ‘acute genital ulcer AND vulva’. We extracted relevant data on ‘type of article’, ‘patients’ age’, ‘amount and localization of ulcers’, ‘presence of flu‐like symptoms’, ‘prior sexual contacts’, ‘diagnostic workup’ (including histology, blood count and serology such as Epstein–Barr virus testing) and ‘treatment/outcome’. Data were meta‐analysed and comparative analyses were discussed in order to create a diagnostic algorithm and recommendations for management. Twenty‐one publications reporting a total of 60 cases of UVAL were included for analysis. On this basis, we formulated a diagnostic and therapeutic algorithm defined by two major and four minor criteria. The major criteria were (i) acute onset of one or more painful ulcerous lesions in the vulvar region and (ii) exclusion of infectious and non‐infectious causes for the ulcer. The minor criteria were (i) localization of ulcer at vestibule or labia minora, (ii) no sexual intercourse ever (i.e. patient was a virgin) or within the last 3 months, (iii) flu‐like symptoms and/or (iv) systemic infection within 2–4 weeks prior to onset of vulvar ulcer. Use of a symptom‐based treatment algorithm based on our proposed major and minor criteria will improve the diagnosis and management of UVAL.

Influence of demodex mites on life quality of patients with acne and rosacea

Background: Ulcus vulvae acutum, also known as Lipschutz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy. Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of Behcet’s. The patient was treated with a combination of 2.5% lidocaine and 2.5% prilocaine creams for 1 week, 2% fusidic acid ointment for 1 week, with no significant progression. Later, the therapy was changed to 0.05% clobetasol propionate ointment for 10 days. Complete healing occurred in about 10 weeks with no scarring. Discussion: Diagnosis of ulcus vulvae acutum in this patient was made by excluding other differential diagnoses. Conclusion: Ulcus vulvae acutum is a difficult diagnosis, and clinician should be aware of this entity especially when encountering young woman without previous sexual experience problem with ulcer. Keywords: ulcus vulvae acutum, genital ulcer, young women

Ulcus vulvae acutum - A rare case

Background: Ulcus vulvae acutum, also known as Lipschutz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy. Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of Behcet’s. The patient was treated with a combination of 2.5% lidocaine and 2.5% prilocaine creams for 1 week, 2% fusidic acid ointment for 1 week, with no significant progression. Later, the therapy was changed to 0.05% clobetasol propionate ointment for 10 days. Complete healing occurred in about 10 weeks with no scarring. Discussion: Diagnosis of ulcus vulvae acutum in this patient was made by excluding other differential diagnoses. Conclusion: Ulcus vulvae acutum is a difficult diagnosis, and clinician should be aware of this entity especially when encountering young woman without previous sexual experience problem with ulcer. Keywords: ulcus vulvae acutum, genital ulcer, young women

Acute Genital Ulcers in a Virgin Adolescent Girl: A Case Report and Literature Review

Acute genital ulcer (AGU) is a painful ulceration of genitalia that presents in especially virgin young women. The differential diagnosis includes venereal (sexually) and non-venereal (non-sexually) transmitted infections, non-infectious diseases, drug reactions, autoimmune conditions, traumatic causes and malignant. However, etiology and pathogenesis of AGU are still unknown. The disease is characterized by an acute onset of flu-like symptoms such as anxiety, fever, myalgia, pharyngotonsillitis, lymphadenopathy, and headache, with single or multiple, deep and painful mainly kissing ulcers on the vulva, on the inner side of labia majora. Ulcers associated with an immunologic reaction to a distant source of infection or inflammation. The aim of this article is to present a case of acute genital ulcer and discuss for documenting the natural history of AGU, as well as making a diagnosis, differential diagnosis, and treatment options.