Chikungunya associated vulvitis: case report and literature review / Vulvite associada a Chikungunya: relato de caso e revisão de literatura

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Introdução: O vírus Chikungunya está se espalhando pelo mundo por conta da migração e da globalização, podendo apresentar sintomas sistêmicos e incomuns. Objetivo: Relatar um caso de infecção pelo vírus detectado em uma mulher por ocasião do exame ginecológico em clínica de patologia vulvar. Relato do caso: Uma mulher caucasiana de 73 anos foi a uma clínica vulvar por causa de dispareunia e queimação vulvar. Úlceras foram observadas nos pequenos lábios e no períneo. O diagnóstico de Chikungunya foi realizado por soroconversão em espécimes pareados. Foi prescrita prednisolona 40 mg uma vez ao dia por dez dias. Após o tratamento com esteróides orais, a mulher não apresentou erupções ou lesões nos órgãos genitais. Conclusão: Este estudo enfatizou que quadros raros de vulvite com úlcera podem estar associados à infecção por Chikungunya.

Vulvitis migratoria causada por gnatostomiasis importada / Migratory vulvitis caused by imported gnathostomiasis

Resumen La gnatostomiasis es una parasitosis emergente en países no endémicos. Este nematodo zoonótico requiere de agua dulce para su ciclo de vida, donde sus larvas se enquistan principalmente en peces. La migración subcutánea de las larvas produce habitualmente una paniculitis eosinofílica de rápido avance. Se describe un caso clínico de un paciente con una lesión migratoria, sin mejoría clínica con terapia antibacteriana. La búsqueda de factores de riesgo, sumado a la evolución y a los hallazgos de laboratorio hizo sospechar el diagnóstico. La gnatostomiasis debe ser sospechado en pacientes con lesiones de piel migratorias, que han consumido pescado crudo durante viajes a países endémicos en Sudamérica o Asia.

Gnathostomiasis is an emerging disease in non-endemic countries. This zoonotic nematode requires aquatic freshwater environments to complete its life cycle where larvae get encrusted in fishes. Typically, the infection manifests as migratory subcutaneous lesion caused by the larvae trak, which produces an eosinophilic panniculitis. Here we describe a patient who presented a migratory lesion with no response to antimicrobial therapy, a careful travel and food history together with specific laboratory tests led to the correct diagnosis. Gnathostomiasis should be suspected in patients with migratory skin lesions who have consumed raw freshwater fish during travel to endemic countries in South America or Asia.

Zoon vulvitis

Abstract Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Vulvitis de Zoon: caso clínico / Zoon vulvitis: clinical case

Se presenta un caso de una paciente de 84 años con vulvitis de Zoon. Se trata de una dermatosis vulvar de etiología incierta, muy poco frecuente, que ocasiona sintomatología inespecífica de prurito y escozor vulvar de larga evolución, acompañados de una o varias lesiones focales circunscritas y eritematosas de difícil diagnóstico clínico. Se insiste en la necesidad de realización de biopsia vulvar para obtención de un diagnóstico histológico de certeza. Se comentan las opciones terapéuticas actuales descritas en la literatura aunque no existe un tratamiento de elección.

An 84 year old female patient with Zoons vulvitis case is reported. It is a rare vulvar dermatosis of unknown etiology, with unspecific symptoms such as pruritus and vulvar stinging, both developed over a long period of time, accompanied with focal erythematous injuries. As a clinical diagnosis remains difficult, it is essential that a biopsy is obtained for accurate histological diagnosis. Despite different therapeutic options available, there is no consensus on a standardized treatment.

Clinical Features and Extraintestinal Manifestations of Crohn Disease in Children / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients. METHODS: The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding baseline demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classification, and clinical features and course of EIMs were investigated. RESULTS: Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean follow-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileocolonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary thromboembolism in 1 (1.4%). CONCLUSION: Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.

Clinical and microbiologic characteristics of vulvovaginitis in Korean prepubertal girls, 2009-2014: a single center experience

OBJECTIVE: To update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls. METHODS: A total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded. RESULTS: Girls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05). CONCLUSION: Specific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.

Idiopathic Granulomatous Vulvitis / 대한피부과학회지

Granulomatous vulvitis is a rare localized inflammatory disease characterized by a painless, swollen, indurated and distorted vulva. Histopathologically, it shows chronic non-necrotizing granulomatous inflammation with edema, fibrosis, and lymphangiectasia. Some cases are associated with granulomatous cheilitis or Crohn's disease. So far, only a few cases of idiopathic granulomatous vulvitis have been reported. A 43-year-old female presented with a 1-year-history of persistent swelling of the vulva. The lesion was enlarged, edematous, and indurated, and there were clustered vesicles and papules on the labia major. Histopathologic examination of the swollen labia major showed granulomatous inflammation composed of multinucleated giant cells and epithelioid cells, with numerous lymphocytes in the dermis. Another biopsy specimen obtained from the clustered vesicles showed lymphangiectasia with chronic inflammation. Based on these characteristic histopathologic features and clinical findings, the patient was diagnosed with idiopathic granulomatous vulvitis. Herein, we reported a rare case of idiopathic granulomatous vulvitis that developed in a healthy woman.

Vulvitis de Zoon / Zoon´s vulvitis

La vulvitis de Zoon fue descripta por primera vez por Zoon y Garnier en 1954. Se trata de una inflamación crónica de la mucosa vaginal, de baja incidencia. La etiopatogenia es desconocida y hasta la fecha no hay descripto ningún tratamiento efectivo. Las características clínicas e histopatológicas remedan su contrapartida masculina, la clásica balanitis circunscripta plasmocelular o de Zoon.

Zoon´s vulvitis was first described by Zoon and Garnier in 1954. It´s a low- prevalence, chronicinflammation of the vaginal mucosa. The etiology is unknown, and an effective standardtreatment has not yet been described. Its clinical and histophatologic features resemble the malecounterpart known as Zoon´s balanitis.

Grau de satisfação de mulheres que usaram absorvente higiênico "respirável" externo por 75 dias consecutivos / Satisfaction of women who used " breathable" panty liners for 75 days consecutively

Introdução: as mulheres modernas desenvolvem 10 a 12 horas de trabalhos consecutivos sem ter facilidades para sua higiene genital, fato que motivou o uso frequente de absorventes higiênicos no período intermenstrual. Objetivo: verificar a satisfação das voluntárias após 75 dias do uso de absorventes "respiráveis" intermenstruais. Métodos: aplicação de questionário para 54 mulheres voluntárias de ensaio clínico sobre o ecossistema vaginal e vulvar,que usaram absorvente higiênico intermenstrual "respirável" externo (AHIRE) por 75 dias, para verificar a satisfação do uso destes absorventes. As voluntárias foram avaliadas clinicamente e responderam a dois questionários sobre atividade laboral, desconforto vulvar (ardor, irritação ou prurido),conhecimento e uso de absorventes intermenstruais, seus motivos para usá-los e satisfação do uso, o primeiro no início e o segundo ao final do estudo.Resultados: as mulheres que participaram deste estudo eram brancas e não brancas em igual proporção, com bom nível educacional, índice de massa corpórea próximo a 25 e com média de 2,06 relações sexuais por semana. A permanência fora de casa é de 7,6 horas por dia, em média. Mais de 85%das voluntárias já conheciam esse tipo de produto, embora apenas 28,3% relatarem o hábito de usar protetor diário durante o período intermenstrual.Não foram identificados sinais irritativos (hiperemia vulvar) em 93,7% das mulheres na visita 2 (após 15 dias de uso) e 93,2% na visita 6 (após 75dias de uso). Queixas espontâneas de desconforto vulvar (ardor e irritação ou prurido) não ocorreram em 91,6% das mulheres na visita 2 e em 95,5%das mulheres na última visita. Essas diferenças não apresentaram significado estatístico (teste exato de Fisher com IC 95%). Estudo complementar indicou que estas porcentagens estão de acordo com a variação encontrada em mulheres que não usaram o AHIRE. Após os 75 dias do estudo, 39mulheres (92,8%) afirmaram que se sentiram mais confiantes, seguras e limpas com o uso do AHIRE. Conclusão: mulheres que usaram absorventesintermenstruais "respiráveis" por 75 dias consecutivos, manifestaram alto grau de satisfação e não apresentaram alterações clínicas significativas(hiperemia) ou reportaram desconforto (ardor e prurido) associado ao uso.

Introduction: modern women develop 10 to 12 consecutive hours of work without having an appropriated genital hygiene, a fact that prompted the frequentuse of panty liners in the intermenstrual period. Objective: check the satisfaction level of subjects after 75 days of wearing "breathable" panty liners (i. e.,ones that allow movement of air and water vapor). Methods: implementation of a questionnaire to 54 women participants of a clinical trial for vulvar andvaginal ecosystem evaluation, who wore breathable panty liner (BPL) for 75 days to verify the satisfaction regarding the wearing there of. The subjects wereassessed for clinical exams and also answered two questionnaires related to work activity, vulvar discomfort (burning, irritation or pruritus), knowledge andwearing of breathable panty liners, their reasons for wearing them as well as satisfaction, being the former at the beginning and latter at the end of the study.Results: the women that attended the research were white and non-white in equal proportions, holding good educational background, body mass indexclose to 25 and with an average of 2.06 sexual intercourses per week, being away from home, on average 7.6 hours per day. Over 85% of subjects werepreviously familiarized with this type of product, albeit just 28.3% reported the habit of wearing panty liners throughout the intermenstrual period. Absenceof irritation signs (vulvar hyperemia) occurred in 93.7% in Visit #2 (after 15 days of usage) and 93.2% of the women in visit #6 (after 75 days). Commoncomplaints of vulvar discomfort (burning and irritation or pruritus) were not observed in 91.6% of the women in Visit #2 and 95.5% of the women in the endof study. These differences were not statistically meaningful (Fisher"s exact test with IC = 95%) between the visits. A complementary study indicates thatthese percentages are in line with the normal variations of women who do not wear panty liners. After 75 days of the study, 39 women (92.8%) said they feltmore confident, protected and clean while wearing BPL. Conclusion: women who used "breathable" panty liners intermenstrual for 75 consecutive days,expressed high satisfaction and showed no clinically significant changes (hyperemia) or reported genital discomfort (burning and itching).

Tiña vulvar: análisis histopatológico de un caso / Tinea of the vulva: a histopathological case analysis

Introducción: la tiña vulvar es una entidad de difícil diagnóstico clínico que puede también pasar desapercibida en la biopsia. Objetivo: presentar el caso de una mujer con esta entidad, diagnosticado por la biopsia, y hacer comentarios relevantes sobre el tema con énfasis en el diagnóstico histopatológico. Metodología: se trata de una paciente sometida a biopsia por prurito vulvar persistente. No se anotan otros datos de historia clínica, incluida la edad. En la biopsia se observó una dermatitis psoriasiforme liquenificada, con paraqueratosis y grupos de neutrófilos en la capa córnea y con tapones córneos infundibulares; en la dermis superficial se apreciaban papilas profundas con algunos linfocitos y fibrosis vertical. Se sospechó el diagnóstico de psoriasis pero la coloración de PAS (coloración de ácido peryódico de Schiff), solicitada por la presencia de neutrófilos intracórneos, demostró abundantes hifas en un infundíbulo confirmándose el diagnóstico de tiña vulvar. Conclusiones: la entidad demostrada es rara y tiene como uno de sus patrones histopatológicos la presencia de una dermatitis psoriasiforme y liquenificada. El hallazgo de neutrófilos intracórneos siempre debe hacer sospechar la presencia de una tiña. La coloración de PAS es una manera fácil de confirmar el diagnóstico. En la literatura revisada se constata que la tiña vulvar es una extensión de la tiña cruris, producida con mayor frecuencia por Trichophyton rubrum. Los diagnósticos diferenciales incluyen candidiasis, psoriasis y dermatitis de contacto.

Introduction: tinea of the vulva is a difficult clinical entity which may well go unnoticed in a biopsy. Objective: presenting the case of a woman suffering this disease, diagnosed by biopsy, and making some comments emphasising the value of histopathological diagnosis. Methodology: a vulvar biopsy was taken as the patient had complained of persistent pruritis. No clinical history was obtained. The biopsy revealed lichenified psoriasiform dermatitis, parakeratosis and groups of neutrophils in the horny layer and infundibulum; deep dermal papillae, lymphocytes and vertical fibrosis were visible in the dermis. Although such findings are also seen in psoriasis, PAS staining was done due to the presence of neutrophils, showing abundant infundibular hyphae, thereby confirming the diagnosis of tinea of the vulva. Conclusions: this rare entity has a lichenified psoriasiform histological pattern. The finding of neutrophils in the horny layer must always lead to suspecting the presence of tinea. PAS staining is an easy way to confirm such diagnosis. Reviewing the literature revealed that tinea of the vulva is an extension of tinea cruris, most frequently caused by Trichophyton rubrum. Differential diagnosis includes candidiasis, psoriasis, and contact dermatitis.

Enfermedad de Paget vulvar / Vulvar Paget`s disease

Se describe el caso de una paciente con diagnóstico de enfermedad de Paget vulvar, la cual fue tratada con cistostático tópico local con criterio coadyuvante al tratamiento quirúrgico. Hubo mejoría clínica evidente, pero la paciente falleció 10 meses después por una afección cardiovascular secundaria a hipertensión arterial. Teniendo en cuenta la escasa frecuencia de esta entidad y de su tratamiento no quirúrgico, con buenos resultados inmediatos, se muestra a la comunidad científica como una opción paliativa o previa a la cirugía definitiva.

The case of a patient with diagnosis of vulvar Paget`s disease, who was treated with local topical cytostatic with coadjutant approach for surgical treatment is described. There was evident clinical improvement, but the patient died 10 months later due to a cardiovascular disorder secondary to hypertension. Keeping in mind the scarce frequency of this disease and of its non surgical treatment, with good immediate results, it is shown to the scientific community as a palliative option or an option previous to the definitive surgery.

Síndrome disestésico cutáneo: vulvodinia y síndrome de boca quemante. Una aproximación diagnóstica y terapÚutica / Cutaneous dysesthesia syndrome: vulvodynia and burnig mouth syndrome. A diagnostic and therapeutic approach

Los síndromes disestesicos cutáneos, aunque infrecuentes en la práctica clínica, constituyen un reto diagnóstico multidisciplinario en donde el dermatólogo se convierte en pieza clave. Por su origen, probablemente multifactorial y frecuentemente idiopático, la valoración inicial debe incluir una historia clínica completa, identificando los posibles factores asociados. Esta revisión busca suministrar al lector herramientas diagnósticas y terapéuticas, útiles para el manejo de pacientes con esta patología.

The cutaneous dysesthesia syndrome are infrequent in medical practice, they constitute a multidisciplinary diagnostic challenge in which the dermatologist is a key element. Due to its multifactorial origin which is usually idiopatic, the inititial evaluation must include a complete clinical history, identifying the possible associated factors. This review is intended to provide the reader with diagnostic and therapeutic tools, useful in the management of these patients.

Liquen escleroso: a propósito de un caso / Lichen sclerosus: apropos of a case

Se presenta la evolución de un liquen escleroso extragenital en una paciente diabética, de 67 años, con discordancia inicial entre la clínica y la histopatología, el cual posteriormente se complicó con un carcinoma espinocelular vulvar. Se realiza una revisión del tema y de la conducta terapéutica, especialmente en mujeres.

Prevalence of gonococcal infections in women with vaginal discharge syndromes in National Institute of Dermato-Venereology, 2001-2002

From 2001 to 2002, 2018 patients with vaginal discharge syndromes were tested at National Institute of Dermato-Venereology. The results showed that 94 patients had gonorrheal-induced vaginal discharge syndromes (4.65%). Among them, 5 patients had gonorrheal-induced vulvitis and 1 patients gonorrheal-induced conjunctivitis. The most gonorrheal infections were a group with aged 16-25 (7.06%) and 26-35 (4.47%)

Bacterial vaginitis at the Institute of Dermato-verereology in the years 2001 - 2002

The study carries on 1209 female patients from 16 to 55 years old at dermatology of dermatological hospital. These patients were tested to diagnose infected Bacteria vaginosis (BV), in particular, they were candled directly under optical microscope with enlargement 1000X to discover BV. The results were the rate infectious BV is the highest at the age group 26 – 35 (2.58%), and the age group 35 – 45 (2.4%), the possitive rate of the age group 26 – 45 is 4.98%. The total of infected patients is 27/1209 patients (2.23%). The rate infected BV of this research is much less than some studies of European countries as Poland, Swede, Belgium, England...

role of colposcopy in the diagnosis and management of chronic vulvar pain [vulvodynia]

Fifty women complaining of chronic vulvar pain and 22 age-matched patients without pain were selected for this study. After full gynecological examination, a histopathologic analysis was carried out and biopsy was taken from any detected lesion. The results showed that vulvodynia was found to be either primary or secondary; the primary is the commonest and may be diffuse or localized and the secondary may be associated with lower genital infection, rectal and/or urethral lesions. The characteristic colposcopic lesion was the acetowhite area with or without the associated micropapillary lesion detected in 24% of the cases. Cases having such lesion showed epithelial koilocytosis by a histopathological examination and it indicated chronic HPV infection. It was concluded that chronic HPV infection is definitely a cause of vulvodynia. Colposcopy examination is essential in these cases as well as histopathology and bacteriology are essential for the confirmation of the diagnosis and planning the management