EP208 - ACUTE GENITAL ULCER (LIPSCHUTZ ULCER) IN 2 ADOLESCENT GIRLS (ID 971)
Abstract
Title of Case:
ACUTE GENITAL ULCER (LIPSCHUTZ ULCER) IN 2 ADOLESCENT GIRLS
Background:
Acute genital ulcers are a rare entity, predominantly in virgin young girls, that can cause great distress to the patient and the parents.
Case Presentation Summary:
We present two cases of acute vulvar ulcers in two sexually inactive adolescents. The first patient is a 13-year-old girl with prodromal systemic symptoms followed a week later by two painful ulcerated genital lesions in a bilateral kissing pattern with dysuria. The second patient is a 12-year-old girl who was referred to the emergency department because of fever and three painful ulcers in the genital area with a six day history of fever and sore throat. Laboratory investigation revealed in both of them elevated inflammatory markers. Serological tests and Polymerase chain reaction for Epstein-Barr virus (EBV), cytomegalovirus (CMV), syphilis and herpes simplex virus (HSV) were negative. The patients were treated with antibiotics and topical wound care with antiseptics. The ulcers in both cases healed within 10 days without leaving scarring.
Learning Points/Discussion:
Acute genital ulcers, also known as Lipschütz ulcer is a self-limited, non-sexually transmitted condition characterized by painful necrotic ulceration of the vulva or lower vagina. Immune response to infectious diseases such as EBV, CMV and M. pneumoniae seems to be associated but, in most cases, the association with an infection could not be confirmed. The differential diagnosis is broad, including infectious agents, autoimmune disorders, and trauma. Diagnosis of Lipschütz ulcer is mainly clinical, after exclusion of other causes of vulvar ulcers. Recognition of Lipschütz ulcer is important to the extent that patients receive appropriate treatment and counseling.
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