Severe acute vulval ulceration secondary to COVID-19
British Journal of Dermatology
; 186(6):e248, 2022.
Article
in English
| EMBASE | ID: covidwho-1956696
ABSTRACT
A 21-year-old woman was admitted with a 3-day history of severe vulval ulceration, oedema and pain. On examination she had large deep necrotic-appearing kissing ulcers on the right and left inner labia minora, with overlying grey eschar and significant surrounding inflammation. The pain was described as agonizing, requiring opioid analgesia and catheterization for micturition. Three weeks prior, she had tested positive for SARS-CoV-2, having had mild symptoms, but her PCR was negative on admission. She had not been sexually active for several months due to dyspareunia. She was initially started on co-amoxiclav and acyclovir due to a raised C-reactive protein of 94, and white cell count of 11. Investigations were negative for Epstein-Barr virus (EBV), HIV and mycoplasma. Bacterial and viral skin swabs were negative. Biopsies were taken under general anaesthesia. Histology revealed ulceration and granulation tissue only. Bacterial and atypical mycobacterial cultures were negative. She was discharged when the ulcers had stabilized and pain was controlled. Follow-up 2 weeks later revealed full healing of the ulceration. Therefore, this is a case of reactive nonsexually acquired acute genital ulceration (AGU), also known as Lipsh€utz ulceration (Sadoghi B, Stary G, Wolf P et al. Ulcus vulvae acutum Lipsch€utz a systematic literature review and a diagnostic and therapeutic algorithm. J Eur Acad Dermatol Venereol 2020;34 1432-9), which is likely to have developed secondary to COVID -19 in this patient. This rare form of vulval ulceration has been previously linked to infections including EBV, cytomegalovirus and mycoplasma. There have been three case reports of AGU linked to COVID -19 (Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep 2021;14 e242653). This is a rare and dramatic presentation that needs to be recognized by the dermatologist to aid timely diagnosis and treatment.
aciclovir; amoxicillin plus clavulanic acid; C reactive protein; endogenous compound; opiate; adult; algorithm; analgesia; bacterium culture; catheterization; conference abstract; coronavirus disease 2019; Cytomegalovirus; dermatologist; drug combination; dyspareunia; edema; Epstein Barr virus; female; follow up; general anesthesia; genital ulcer; granulation tissue; histology; histopathology; human; Human immunodeficiency virus; human tissue; inflammation; labia minora; leukocyte count; micturition; Mycoplasma; nonhuman; Severe acute respiratory syndrome coronavirus 2; skin; systematic review; vulva; young adult
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
British Journal of Dermatology
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS