Lipschütz Ulcer: A Rare Cause of Genital Ulcer

Background: ulcer (LU) is an uncommon disease characterized by vulvar ulcerations with sudden onset in nonsexually active girls or young women. It has a diagnosis of exclusion, discarding sexually transmitted ulcers, autoimmune diseases or trauma lesions. Most cases are idiopathic but several viral and bacterial infections have been envolved.

Objective: We report a case of acute onset of vulvodynia presented in emergency department (ED).

Methods: Case report

Results: A 13 years old female presented to pediatric ED reporting acute vulvar pain and dysuria for the last 24 hours. Fever, mialgias, rhinorrhea, astenia and odynophagia had begun three days before. Genital examination showed two ulcers with red border and a central gray-black eschar one in left labia minor and the other in vulvar haipin. Blood test showed discrete leucocitosis and C-reactive protein 30 mg/L. Influenza A/B test, urianalysis and throat swab test for Group A Streptococcus were negative. The ulcer swab culture was also negative. We started oral and topic analgesia (lidocaine 2%) and warm stiz baths. Two days later, she reconsulted at primary care associating cough and otalgia with diseminated wheezings and right acute otitis media at physical examination. She started inhaled bronchodilators and based on the suspicion of Mycoplasma Pneumoniae (MP) infection, oral macrolide was prescribed. Two days after she was afebrile with better general conditions. Serological tests showed EBV, CMV, HSV negatives and IgM MP positive in >1/256. The ulcer complete healed in about two weeks with no scarring.

Conclusion: LU is an infrecuent disease that typically present in sexually inactive girls. It is probably misdiagnosed by pediatrician who are unaware of them. The diagnosis is based on clinical features and exclusion of other causes of genital ulcers. Although most of the cases are idiopathic, EBV is the most identified cause but MP is also reported.