Lipschütz Ulcer and Epstein-Barr Virus Infection

A Case Report

Authors

DOI:

https://doi.org/10.15448/1980-6108.2021.1.39653

Keywords:

adolescence, lipschütz ulcer, epstein-barr virus

Abstract

Aims: Lipschütz ulcer (LU), also known as acute vulvar ulcer, is a rare cause of vulvar ulcerations of nonvenereal origin. Our aim is to alert about this manifestation of the disease and to prevent unnecessary treatment.
Case description: we present a 15 years old female, without relevant family and past history, admitted in the emergency room with a painful vulvar ulcer, preceded by five days of fever and sore throat. On physical examination, she had enlarged, and erythematous tonsils and bilateral anterior cervical lymphadenopathy and the genital examination revealed vulvar oedema and a deep ulcer with necrotic plaques in labium minus. The exclusion of transmitted sexual disease led to a diagnosis of Lipschütz ulcer. She started symptomatic treatment, oral antibiotic and corticoid therapy. She was discharged from the hospital after 6 days of admission and returned to a consult one month later when it was observed an almost complete resolution of the lesions. No recurrences occurred until 3 months.
Conclusion: LU is a misdiagnosed pathology, probably because doctors, in general, are not familiarized with that, and since the diagnosis is made by exclusion. Infectious, such as Epstein-Barr Virus infections, are proposed etiologies.

Downloads

Download data is not yet available.

Author Biographies

Íris Santos Silva, Hospital Sousa Martins, Unidade Local de Saúde da Guarda; Paediatric Department, Guarda, Portugal.

Master in Medicine from Faculty of Medicine of the University of Porto (FMUP); pediatric resident in Hospital Sousa Martins (ULS), Guarda, Portugal.

João Virtuoso, Hospital Sousa Martins, Unidade Local de Saúde da Guarda; Paediatric Department, Guarda, Portugal.

Master in Medicine from Faculty of Medicine of University of Lisboa; pediatric resident in Hospital Sousa Martins (ULS), Guarda, Portugal.

Joana Filipe Ribeiro, Hospital Sousa Martins, Unidade Local de Saúde da Guarda; Paediatric Department, Guarda, Portugal.

Master in Medicine from Faculty of Medicine of the University of Porto (FMUP); pediatric resident in Hospital Sousa Martins (ULS), Guarda, Portugal.

Glória Silva, Hospital Sousa Martins, Unidade Local de Saúde da Guarda; Paediatric Department, Guarda, Portugal.

Master in Medicine from Institute of biomedical Sciences Abel Salazar (ICBAS) of University of Porto; pediatrician in Hospital Sousa Martins (ULS), Guarda, Portugal.

Rita S. Oliveira, Hospital Sousa Martins, Unidade Local de Saúde da Guarda; Paediatric Department, Guarda, Portugal.

Master in Medicine from Faculty of Medical Sciences of University NOVA de Lisboa; pediatrician in Hospital Sousa Martins (ULS), Guarda, Portugal.

References

Schindler Leal AA, Piccinato CA, Beck APA, Gomes MTV, Podgaec S. Acute genital ulcers: keep in mind. Arch Gynecol Obstet. 2018;298(5):927-31. https://doi.org/10.1007/s00404-018-4866-6

Bounniyt H, Mael-Ainin M, Bouhallab J, Hassam B. Lipschütz ulcer: a rare case of genital ulcers. Presse Med. 2015;44(1):117-8. https://doi.org/10.1016/j.lpm.2014.04.018

Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A. Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein–Barr primoinfection. Eur J Pediatr. 2013;172(8):1121-23. https://doi.org/10.1007/s00431-013-2013-8

Vismara SA, Lava SAG, Kottanattu L, Simonetti GD, Zgraggen L, Clericetti CM, et al. Lipschütz’s acute vulvar ulcer: a systematic review. Eur J Pediatr. 2020;179(10):1559-67. https://doi.org/10.1007/s00431-020-03647-y

Truchuelo MT, Vano-Galván S, Alcántara J, Pérez B, Jaén P. Lipschütz ulcers in twin sisters. Pediatr Dermatol. 2012;29(3):370-2. https://doi.org/10.1111/j.1525-1470.2011.01715.x

Sárdy M, Wollenberg A, Niedermeier A, Flaig MJ. Genital ulcers associated with Epstein-Barr virus infection (ulcus vulvae acutum). Acta Derm Venereol. 2011;91(1):55-9. https://doi.org/10.2340/00015555-0979

Bolis V, Karadedos C, Chiotis I, Chaliasos N, Tsabouri S. Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge. J Pediatr (Rio J). 2016; 92(2):11-21. https://doi.org/10.1016/j.jped.2015.06.007

Arellano J, Fuentes E, Moreno P, Corredoira Y. Úlcera de Lipschütz, un diagnóstico para considerar en la población pediátrica. Arch Argent Pediatr. 2019;117(3):e305-e308. https://doi.org/10.5546/aap.2019.e305

Vieira-Baptista P, Lima-Silva J, Beires J, Martinez- de-Oliveira J. Lipschütz ulcers: should we rethink this? An analysis of 33 cases. Eur J Obstet Gynecol Reprod Biol. 2016; 198:149-52. https://doi.org/10.1016/j.ejogrb.2015.07.016

Farhi D, Wendling J, Molinari E, Raynal J, Carcelain G, Morand P, et al. Non-sexually related acute genital ulcers in 13 pubertal girls: A clinical and microbiological study. Arch Dermatol. 2009;145(1):38-45. https://doi.org/10.1001/archdermatol.2008.519

Vieira-Baptista P, Machado L, Costa AR, Beires J, Martinez-de-Oliveira J. Mycoplasma pneumoniae: a rare cause of vulvar ulcers or an undiagnosed one? J Low Genit Tract Dis. 2013;17(3):330-4. https://doi.org/10.1097/lgt.0b013e3182710896

Limão S, Ventura A, Queirós G, Cunha F. Lipschütz ulcer and group A streptococcal tonsillitis. BMJ Case Rep. 2018;2018:bcr2017223579. https://dx.doi.org/10.1136%-2Fbcr-2017-223579

Jerdan K, Aronson I, Hernandez C, et al. Genital ulcers associated with Epstein-Barr virus. Cutis. 2013; 91(6):273-6.

Charamanta M, Soldatou A, Michala L. Vulvar Ulcers in Children: Dramatic But Self-Limited. Pediatr Emerg Care. 2021;37(2):70-2. https://doi.org/10.1097/pec.0000000000002004

Hueto Najarro A, González García G, Breton Hernández P, et al. Úlceras genitales de Lipschütz: reporte de un caso pediátrico. Arch Argent Pediatr. 2017;115(6):e436-e439.

Brinca A, Canelas MM, Carvalho MJ, Vieira R, Figueiredo A. Lipschütz ulcer (ulcus vulvae acutum): A rare cause of genital lesion. An Bras Dermatol. 2012; 87(4):622-4. https://doi.org/10.1590/S0365-05962012000400018

Downloads

Published

2021-12-20

How to Cite

Silva, Íris S., Virtuoso, J., Ribeiro, J. F., Silva, G., & Oliveira, R. S. (2021). Lipschütz Ulcer and Epstein-Barr Virus Infection: A Case Report. Scientia Medica, 31(1), e39653. https://doi.org/10.15448/1980-6108.2021.1.39653

Issue

Section

Case Reports

Most read articles by the same author(s)