Lipschütz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room.

Background: Primary acute genital ulcers, or Lipschütz ulcers (LU), are nonsexually transmitted, painful, self-limiting, nonrecurrent vulvar ulcers with unclear pathogenesis, representing a challenging diagnosis in emergency setting. LU have recently been described in association with severe acute respiratory syndrome coronaVirus 2 (SARS-CoV-2) infection and vaccination. Objective: The aim of this study is to describe 2 cases of LU due to SARS-CoV-2 infection, highlighting the diagnostic process, differential diagnosis, disease course, and management options. Methods: We describe 2 young females (12 and 9 years old) who presented to pediatric emergency room with the sudden onset of well-demarcated, painful, vulvar ulcers with fibrinous necrotic center. Results: Both patients tested positive to SARS-CoV-2 nasal swab, and, at physical examination, no other lesions were found in other cutaneous or mucosal sites. Sexual abuse was excluded in both cases, as well as infectious and autoimmune diseases. Supportive analgesic therapy was administered, and complete remission of lesions was observed at follow-up visits without evidence of scarring. Limitations: The main limitation of this work is represented by the small number of cases described. Conclusion: Even though extremely rare, LU related to COVID-19 are an emerging entity to be considered in the diagnosis of acute genital ulcerations. Multidisciplinary diagnostic workup of genital ulcers must be established in order to exclude sexual child abuse, to ensure patient safety, and to avoid unnecessary treatment and familial anxiety.

Propuesta para superar las dificultades diagnósticas de las úlceras de Lipschütz, a propósito de un caso / Proposal to overcome the diagnostic difficulties of Lipschütz ulcers. A case study

La úlcera de Lipschütz, llamada así por el dermatólogo austríaco que la describió por primera vez en 1913, es una patología poco frecuente que se debe considerar en el diagnóstico diferencial de las úlceras genitales de mujeres con o sin vida sexual activa. Es precedida por síntomas sistémicos típicos de una viriasis y tiene buen pronóstico por su curso autolimitado. La falta de conocimiento de esta entidad (sobre todo en su etiopatogenia), su baja incidencia y la ausencia de criterios diagnósticos claros contribuyen a que siga siendo infradiagnosticada. Con el presente trabajo, pretendemos minimizar este problema al crear un método diagnóstico simplificado que a su vez permite una clasificación pionera.(AU)

Lipschütz ulcer is named after the Austrian dermatologist who first reported this in 1913. It’s a rare pathology that should be considered in the differential diagnosis of genital ulcers in women with or without an active sexual life. It’s preceded by systemic symptoms typical of a viral infection and it has a good prognosis as it’s self-limited. This entity is underdiagnosed due to limited knowledge (especially in aetiopathogenesis), its low incidence and because there are no clear diagnostic criteria. We tried to improve this problem by creating a simplified diagnostic method and a pioneer classification.(AU)

Lipschütz Ulcer and SARS-CoV-2: What We Currently Know?

BACKGROUND: In recent years, several interesting case reports have been published which describe the possible role of SARS-CoV-2 infection or vaccination in the etiopathogenesis of Lipschütz ulcer. Our aim is to analyze this association and provide a rapid algorithm that is of support to gynecologists and dermatologists both in the diagnosis and in setting up the therapy. To do so, in this paper, we describe an interesting case of acute vulvar ulcer triggered by SARS-CoV-2 infection and review the related literature. METHODS: We conducted a literature review including papers published between October 2021 and April 2023, and we described the case of a patient referred to our clinic with Lipschütz ulcer and SARS-CoV-2 infection. RESULTS: In almost all cases analyzed, a correlation with SARS-CoV-2 infection or vaccination was found; ulcers usually manifest after 2 to 4 weeks and are associated with flu-like symptoms. A concordance in review papers, as well as in our case report, was also found about the treatment, which is mainly symptomatic. CONCLUSIONS: Previous infection or vaccination for SARS-CoV-2 should be included as possible etiopathogenetic factors in the onset of Lipschütz ulcer.

COVID-19, Coronavirus Vaccines, and Possible Association with Lipschütz Vulvar Ulcer: A Systematic Review.

Lipschütz genital ulcer is a self-limited, non-sexually acquired disorder characterized by the sudden onset of a few ulcers. A primary Epstein-Barr virus infection is currently considered the most recognized cause. Recent reports document cases temporally related with coronavirus disease 2019 (COVID-19) or immunization against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We carried out a review of the literature to investigate the possible association between COVID-19 or the immunization against SARS-CoV-2 and genital ulcer. The pre-registered study (CRD42023376260) was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Excerpta Medica, the National Library of Medicine, and Web of Sciences were searched. Inclusion criteria encompassed instances of acute Lipschütz ulcer episodes that were temporally linked to either COVID-19 or a vaccination against SARS-CoV-2. Eighteen articles were retained. They provided information on 33 patients 15 (14-24) years of age (median and interquartile range), who experienced a total of 39 episodes of Lipschütz ulcer temporally associated with COVID-19 (N = 18) or an immunization against SARS-CoV-2 (N = 21). The possible concomitant existence of an acute Epstein-Barr virus infection was excluded in 30 of the 39 episodes. The clinical presentation and the disease duration were similar in episodes temporally associated with COVID-19 and in those associated with an immunization against SARS-CoV-2. In conclusion, COVID-19 and immunization against SARS-CoV-2 add to Epstein-Barr virus as plausible triggers of Lipschütz genital ulcer.

An update on Epstein-Barr virus-and human T-lymphotropic virus type-1-induced cutaneous manifestations. CME Part II.

The Epstein-Barr virus (EBV) is a DNA virus that infects 90% of the human population, is responsible for certain cutaneous lymphomas (extranodal NK/T-cell lymhoma, hydroa vacciniforme lymphoproliferative disorder, lymphomatoid granulomatosis, others), and can be associated with a variety of cutaneous manifestations (eg, infectious mononucleosis, severe mosquito bite allergy, chronic active EBV disease, Gianotti-Crosti syndrome). EBV-related skin disorders are frequent in certain populations (South and Cental America, Africa, Asia, and Oceania) and can be diagnostically challenging. The human T-lymphotropic virus type-1 is a retrovirus, which is known to be associated with adult T-cell leukemia/lymphoma, neurologic disorders, but also cutaneous non-neoplastic manifestations (infective dermatitis, infections, and infestations). We performed an updated revision of the clinical dermatologic and histopathologic findings associated with the cutaneous non-neoplastic and preneoplastic disorders occurring in association with the EBV and human T-lymphotropic virus type-1.

COVID-19 related acute genital ulcer: a case report

ABSTRACT Acute vulvar ulcer (Lipschütz's ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet's syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz's ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.

Forma necrótica de úlcera de Lipschütz / Necrotic type of Lipschütz ulcer

Resumen INTRODUCCIÓN: Las úlceras de Lipschütz son una causa infrecuente de úlcera genital, de alivio espontáneo y casi siempre benignas, aunque en algunas pacientes pueden dejar cicatrices genitales. Lo común es que aparezcan en mujeres jóvenes, antes del inicio de la vida sexual activa, en coincidencia con un cuadro catarral o pseudogripal. CASO CLÍNICO: Paciente de 18 años con una úlcera vulvar dolorosa, coincidente con un episodio de amigdalitis aguda y fiebre de 38 ºC. La paciente negó haber tenido relaciones sexuales. La úlcera alcanzó 3 a 4 cm, profunda, purulenta, con apertura del labio menor derecho y con importante componente necrótico. Para el control del dolor se le indicaron: corticoides, doxiciclina oral, crema con lidocaína y antiinflamatorios. Los análisis de laboratorio descartaron que se tratara de infección de trasmisión sexual. Al término del esquema terapéutico prescrito la evolución fue favorable, con desaparición de los síntomas, pero con una secuela: apertura del labio mayor derecho. CONCLUSIONES: La úlcera de Lipschütz es una causa infrecuente de úlcera vulvar. Su tratamiento consiste en el control de los síntomas y casi siempre se cura en el transcurso de 4 a 6 semanas, sin dejar lesiones. El diagnóstico solo puede establecerse luego de excluir otras causas más frecuentes de úlcera vulvar.

Abstract INTRODUCTION: Lipschütz ulcers are an infrequent cause of genital ulcer, of spontaneous relief and almost always benign, although in some patients they may leave genital scars. They usually appear in young women, before the onset of active sexual life, coinciding with a catarrhal or flu-like condition. CLINICAL CASE: 18-year-old female patient with a painful vulvar ulcer, coinciding with an episode of acute tonsillitis and fever of 38 ºC. The patient denied having had sexual intercourse. The ulcer was 3 to 4 cm, deep, purulent, with opening of the right labium minora and with a significant necrotic component. For pain control she was prescribed corticosteroids, oral doxycycline, lidocaine cream and anti-inflammatory drugs. Laboratory tests ruled out sexually transmitted infection. At the end of the prescribed therapeutic scheme the evolution was favorable, with disappearance of symptoms, but with a sequel: opening of the right labium majus. CONCLUSIONS: Lipschütz ulcer is a rare cause of vulvar ulcer. Its treatment consists of symptom control and it almost always heals within 4 to 6 weeks, leaving no lesions. The diagnosis can only be established after other more frequent causes of vulvar ulceration have been excluded.

Murine Typhus Presenting With Mucosal Involvement.

Lipschutz ulcers (LU) present as painful genital ulcers in nonsexually active females. Associated infections include Epstein Barr virus, Mycoplasma pneumoniae, Cytomegalovirus, and influenza. To our knowledge, this is the first report of LU occurring with murine typhus. Murine typhus is caused by Rickettsia typhi, a Gram-negative, obligate intracellular organism. Rat fleas (Xenopsylla cheopis) are the classic vector, although cat fleas (Ctenocephalides felis) found on cats, dogs, and opossums have been implicated in maintaining the life cycle of R. typhi in suburban areas. Murine typhus can have a nonspecific presentation making a strong index of suspicion crucial to its diagnosis. The most common presenting signs include fever, poor appetite, malaise, and headache. Laboratory abnormalities may include elevated C-reactive protein, elevated erythrocyte sedimentation rate, hypoalbuminemia, elevated transaminases, elevated neutrophil band count, and thrombocytopenia. The treatment of choice for R. typhi is doxycycline.

Lipschütz ulcer and Epstein-Barr virus infection: a case report / Úlcera de Lipschütz e infecção pelo vírus Epstein-Barr: um relato de caso

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.

Objetivo: a úlcera de Lipschütz, ou úlcera vulvar aguda, é uma causa rara de ulceração de origem não venérea. O nosso objetivo é alertar para essa manifestação da doença e prevenir tratamentos desnecessários. Descrição: adolescente, sexo feminino, 15 anos, sem história pessoal ou antecedentes familiares de relevo. Recorreu ao Serviço de Urgência por febre e odinofagia, com cinco dias de evolução, associada a uma úlcera vulvar dolorosa, que surgiu no próprio dia. O exame clínico revelou amígdalas hipertrofiadas e eritematosas, linfadenopatia cervical anterior, e o exame ginecológico apresentou edema da vulva e uma úlcera profunda, com placas necróticas nos lábios menores. A exclusão de uma doença sexualmente transmissível levou ao diagnóstico de úlcera de Lipschütz. Ficou internada no Serviço de Pediatria e iniciou tratamento sintomático, antibioterapia por sobreinfeção da úlcera e corticoterapia tópica. Teve alta após seis dias de hospitalização e foi reavaliada em consulta um mês depois, com resolução completa do caso. Não apresentou recorrência da úlcera até aos três meses seguintes. Conclusão: a úlcera de Lipschütz é uma doença subdiagnosticada, muito provavelmente porque os médicos não estão familiarizados com ela e por ser um diagnóstico de exclusão. A infeção pelo vírus Epstein-Barr é uma das etiologias propostas.

Úlceras vulvares agudas en adolescentes, reporte de una serie de casos clínicos / Severe vulvar ulcers in adolescents, a report of clinical cases series / Úlceras vulvares agudas em adolescentes, informe de uma série de casos clínicos

Introducción: las úlceras genitales se caracterizan por su gran heterogeneidad clínica y etiológica. Pueden corresponder a entidades patológicas cutáneas o sistémicas de naturaleza infecciosa o no infecciosa. Dentro de estas últimas, se destacan las úlceras de Lipschütz y la enfermedad de Behcet. Objetivo: describir cuatro casos clínicos de adolescentes con úlceras vulvares agudas de causa no infecciosa hospitalizadas en dos prestadores del Sistema Nacional Integrado de Salud de Montevideo con el objetivo de brindar herramientas a profesionales para el correcto abordaje diagnóstico y terapéutico. Discusión: la realización de una anamnesis detallada y un examen físico minucioso son esenciales para realizar un adecuado abordaje diagnóstico y terapéutico. En el análisis clínico es importante considerar la edad de la paciente, el inicio de relaciones sexuales, el número, topografía y características de las úlceras incluyendo la presencia o no de dolor, así como la asociación de manifestaciones sistémicas. Resulta necesario el conocimiento de esta patología poco frecuente en niñas y adolescentes cuyo abordaje diagnóstico y terapéutico depende de la orientación etiológica basada en criterios epidemiológicos y clínicos bien definidos. Ello contribuirá a mejorar la calidad de la asistencia y a minimizar las repercu¬siones biológicas y psicológicas.

Introduction: genital ulcers are characterized by great clinical and etiological heterogeneity. They may correspond to infectious or non-infectious skin or systemic pathologies. Lipschütz ulcer and Behcet disease stand out among non-infectious conditions. Objective: to describe four clinical cases of adolescents with non-infectious severe vulvar ulcers hospitalized in two institutions of the national integrated health system in Montevideo, with the purpose of providing professionals with tools for the adequate diagnostic and therapeutic approach. Discussion: a detailed anamnesis questionnaire and a thorough physical examination are of the essence for an adequate diagnostic and therapeutic approach. The clinical analysis should include considering the patient's age, initiation of sexual intercourse, the number, topography and characteristics of the ulcers including finding out whether there is pain or not, as well as the association of systemic manifestations. It is important to learn about this rather unusual condition in girls and adolescents, whose diagnostic and therapeutic approach depends on the etiological orientation based on well-defined epidemiological and clinical criteria. This will contribute to improving the quality of assistance and minimizing biological and psychological effects.

Introdução: as úlceras genitais se caracterizam por uma grande heterogeneidade clínica e etiológica. Podem ser causadas por patologias cutâneas ou sistémicas tanto infecciosas como não infecciosas. Entre as últimas, destacam-se as úlceras de Lipschütz e a doença de Behçet. Objetivo: descrever quatro casos clínicos de adolescentes com úlceras vulvares agudas de causa não infecciosa hospitalizadas em duas unidades de saúde do sistema nacional integrado de saúde de Montevidéu buscando oferecer ferramentas para uma correta abordagem diagnóstica e terapêutica. Discussão: é fundamental realizar uma anamnese detalhada e um exame físico minucioso para uma abordagem diagnóstica e terapêutica adequada. O exame clínico deve incluir a idade da paciente, o inicio das relações sexuais, o número, topografia e características das úlceras incluindo a presencia ou não de dor, bem como a associação com manifestações sistémicas. É necessário conhecer esta patologia pouco frequente em meninas e adolescentes cuja abordagem diagnóstica e terapêutica depende da orientação etiológica baseada em critérios epidemiológicos e clínicos bem definidos. Isso contribuirá para melhorar a qualidade da assistência e a minimizar as repercussões biológicas e psicológicas.

Úlcera vulvar aguda de Lipschütz / Acute vulvar ulcer of Lipschütz

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

Úlcera de Lipschütz, un diagnóstico para considerar en la población pediátrica / Ulcer of Lipschütz, a diagnosis to consider in the pediatric population

La úlcera vulvar aguda o úlcera de Lipschütz corresponde a una entidad poco frecuente, por lo general, subdiagnosticada. Se caracteriza por la aparición súbita o aguda de lesiones ulcerosas y dolorosas en la vulva, la vagina y/o el periné, sin antecedente de contacto sexual en niñas y adolescentes. Su etiología permanece desconocida en la mayoría de los casos, aunque se ha asociado a agentes infecciosos. Para su estudio, se deben sospechar infecciones de transmisión sexual, reacciones adversas a medicamentos, enfermedades autoinmunes e inmunosupresión. Las lesiones ulcerosas desaparecen espontáneamente, de manera habitual, sin secuelas ni recurrencias a largo plazo. Se presenta el caso de una paciente adolescente de 11 años, sin inicio de actividad sexual ni menarquia y que consultó por un cuadro prodrómico de cuatro días, seguido del desarrollo agudo de úlceras genitales. Se discuten sus causas, presentación clínica, diagnósticos diferenciales y tratamiento.

Acute vulvar ulcer or ulcer of Lipschütz corresponds to a rare disease, being usually underdiagnosed. It is characterized by a sudden or acute development of ulcerous and painful lesions in the vulva, vagina and/or perineum, without a previous history of sexual contact in girls and teenagers. Its etiology remains unknown in most cases, although they have been associated with infectious agents. Their study includes the suspicion of sexually transmitted infections, adverse drug reactions, autoimmune diseases and immunosuppression. The ulcerative lesions disappear spontaneously, usually without sequelae or recurrences in the long term. We present the case of an 11-year-old adolescent patient, without sexual initiation, or menarche and who consulted due to a four-day prodromal condition, followed by the acute development of genital ulcers. Its causes, clinical presentation, differential diagnosis and treatment are discussed.

[Ulcer of Lipschütz, a diagnosis to consider in the pediatric population]. / Úlcera de Lipschütz, un diagnóstico para considerar en la población pediátrica.

Acute vulvar ulcer or ulcer of Lipschütz corresponds to a rare disease, being usually underdiagnosed. It is characterized by a sudden or acute development of ulcerous and painful lesions in the vulva, vagina and/or perineum, without a previous history of sexual contact in girls and teenagers. Its etiology remains unknown in most cases, although they have been associated with infectious agents. Their study includes the suspicion of sexually transmitted infections, adverse drug reactions, autoimmune diseases and immunosuppression. The ulcerative lesions disappear spontaneously, usually without sequelae or recurrences in the long term. We present the case of an 11-year-old adolescent patient, without sexual initiation, or menarche and who consulted due to a four-day prodromal condition, followed by the acute development of genital ulcers. Its causes, clinical presentation, differential diagnosis and treatment are discussed.

La úlcera vulvar aguda o úlcera de Lipschütz corresponde a una entidad poco frecuente, por lo general, subdiagnosticada. Se caracteriza por la aparición súbita o aguda de lesiones ulcerosas y dolorosas en la vulva, la vagina y/o el periné, sin antecedente de contacto sexual en niñas y adolescentes. Su etiología permanece desconocida en la mayoría de los casos, aunque se ha asociado a agentes infecciosos. Para su estudio, se deben sospechar infecciones de transmisión sexual, reacciones adversas a medicamentos, enfermedades autoinmunes e inmunosupresión. Las lesiones ulcerosas desaparecen espontáneamente, de manera habitual, sin secuelas ni recurrencias a largo plazo. Se presenta el caso de una paciente adolescente de 11 años, sin inicio de actividad sexual ni menarquia y que consultó por un cuadro prodrómico de cuatro días, seguido del desarrollo agudo de úlceras genitales. Se discuten sus causas, presentación clínica, diagnósticos diferenciales y tratamiento.

Acute genital ulcers: keep Lipschütz ulcer in mind.

AIM: Lipschütz ulcers (LU) were first described as rare vulvar ulcerations that affect adolescents without previous history of sexual contact. However, more LU patients have been identified in acute genital ulcers (AGU) services in Europe. PURPOSE: To review cases of AGU and analyze the occurrence of LU in the Ob/Gyn Emergency Department of a Brazilian private hospital, using the currently used diagnostic criteria. METHODS: All female patients who sought our service with AGU complaints from January 2009 to July 2015 were selected and had their medical records reviewed, considering the clinical data and some diagnostic criteria, that included: < 20 years old, first AGU episode, sudden onset, absence of sexual contact 3 months before onset and the absence of immunodeficiency. RESULTS: 273 patients eligible for analysis were identified according to the criteria and 12 (4.39%) of them were identified with the possible diagnosis of LU. By applying less restrictive criteria that allowed the inclusion of patients of any age and sexual status, 98 were identified (35.89%). CONCLUSIONS: Despite being described as a rare pathology, ours and previous results indicate a considerable number of AGU cases, suggesting that LU should be better known and considered for differential diagnosis.

Reactive nonsexually related acute genital ulcers.

The case of a 19-year-old Japanese woman with reactive nonsexually related acute genital ulcers.

Úlceras genitales de Lipschütz: reporte de un caso pediátrico / Lipschütz ulcers: a pediatric case report

Las úlceras genitales son una patología poco frecuente en las consultas de pediatría, pero que generan gran ansiedad familiar. Las úlceras de Lipschütz son úlceras vulvares agudas, dolorosas y autolimitadas de causa desconocida. Aparecen en mujeres jóvenes que no han tenido relaciones sexuales previas o tras un período de abstinencia. Paciente de 10 años con úlceras vulvares dolorosas que, tres días antes de la aparición de las lesiones, había presentado un cuadro de deposiciones diarreicas y fiebre. Se realizó una anamnesis y exploración física detallada y se llevaron a cabo diferentes pruebas complementarias para descartar enfermedades infecciosas de origen venéreo y no venéreo, todas ellas negativas. Se indicó tratamiento sintomático, y se observó, al mes, una completa resolución del cuadro, por lo que se confirmó el diagnóstico de úlceras de Lipschütz.

Genital ulcers are a rare entity in pediatric consultation, but they generate great family anxiety. Lipschütz ulcers are acute, painful, and self-limiting vulvar ulcers of unknown cause. These ulcers appear in young women who have not had previous sexual intercourse or after a period of sexual abstinence. We present a 10-year-old girl with painful vulvar ulcers with a 3-day history of diarrhea and fever before the onset of the lesions. A complete anamnesis and detailed physical examination were carried out and complementary tests were performed to investigate sexually and non-sexually transmitted disease; the results were negative. Symptomatic treatment was started; at one-month follow-up a complete resolution of ulcers confirmed the diagnosis of ulcer of Lipschütz.

[Lipschütz ulcers: a pediatric case report]. / Úlceras genitales de Lipschütz: reporte de un caso pediátrico.

Genital ulcers are a rare entity in pediatric consultation, but they generate great family anxiety. Lipschütz ulcers are acute, painful, and self-limiting vulvar ulcers of unknown cause. These ulcers appear in young women who have not had previous sexual intercourse or after a period of sexual abstinence. We present a 10-year-old girl with painful vulvar ulcers with a 3-day history of diarrhea and fever before the onset of the lesions. A complete anamnesis and detailed physical examination were carried out and complementary tests were performed to investigate sexually and non-sexually transmitted disease; the results were negative. Symptomatic treatment was started; at one-month follow-up a complete resolution of ulcers confirmed the diagnosis of ulcer of Lipschütz.

Las úlceras genitales son una patología poco frecuente en las consultas de pediatría, pero que generan gran ansiedad familiar. Las úlceras de Lipschütz son úlceras vulvares agudas, dolorosas y autolimitadas de causa desconocida. Aparecen en mujeres jóvenes que no han tenido relaciones sexuales previas o tras un período de abstinencia. Paciente de 10 años con úlceras vulvares dolorosas que, tres días antes de la aparición de las lesiones, había presentado un cuadro de deposiciones diarreicas y fiebre. Se realizó una anamnesis y exploración física detallada y se llevaron a cabo diferentes pruebas complementarias para descartar enfermedades infecciosas de origen venéreo y no venéreo, todas ellas negativas. Se indicó tratamiento sintomático, y se observó, al mes, una completa resolución del cuadro, por lo que se confirmó el diagnóstico de úlceras de Lipschütz.

Ulcus vulvae acutum Lipschütz in two young female patients.

Ulcus vulvae acutum Lipschütz or acute genital ulcer is a distinct clinical entity characterized by sudden painful genital ulceration occurring mostly in young and virgin girls with malaise, fever and other systemic symptoms. This distressing syndrome is rare and may be presented to dermatologists, gynecologists or pediatricians. Its diagnosis and therapy can be challenging. We present two young female patients with ulcus vulvae acutum. The cause of the disease could not be confirmed in our patients, but, interestingly, both patients had partial IgA deficiency. In the last 100 years, after its first description by Lipschütz, many case reports and series have aimed to identify a specific cause of the disease, without success. These studies mainly focused on infectious agents as causative factors, however, in most cases connection with infection could not be confirmed. Our opinion is that the decreased level of IgA could be a possible explanation for the cause of this syndrome. With our cases we would like to emphasize the possible role of local immunological mechanisms rather than several infectious agents in the development of this little-known disease.