Obstructed hemivagina and ipsilateral renal anomaly (OVHIRA) syndrome is a congenital urogenital malformation that associates a bifid uterus with a longitudinal vaginal septum, resulting in a blind hemivagina and an ipsilateral renal agenesis. The clinical presentation is highly variable, delaying diagnosis and leading to important complications. An 18-year-old woman was diagnosed with OVHIRA syndrome following acute urinary retention. An agenesis in the left-sided renal system and an enormous pelvic mass compressing the adjacent structures were revealed in the intravenous urography. Nuclear magnetic resonance was the imaging modality that provided most diagnostic information, defining the pelvic mass as a giant left hematometrocolpos contained with a longitudinal vaginal septum. Resection of the septum was performed draining all reduced hematic content and both hemiuteri communicated with a single vagina, resulting in an asymptomatic patient. OVHIRA syndrome is a little known entity that can occur atypically, which makes the diagnosis difficult and delays the treatment. It is important to maintain a high degree of clinical suspicion to avoid irreversible complications.
IntroductionThe vaginal symptoms such as profuse vaginal discharge or dyspareunia are the most common reasons to visit the gynaecologist. However, in most cases, they are treated empirically, leading to diagnosis of the most frequent causes of vaginitis such as infectious ones (1). The symptoms perpetuate in time with no improvement at a low percentage of women, affecting their quality of life. It is then that the clinician has to maintain a high clinical suspicion and use the necessary tests to attain the correct diagnosis. This is the case of a patient who suffered severe incapacitating dyspareunia for a long time. Finally, she was correctly diagnosed as desquamative inflammatory vaginitis (DIV) and the specific treatment for her was prescribed. Consequently, there was a clear symptomatic improvement. Case presentationA 40-year-old woman presented to our unit complaining mostly about three years of dyspareunia, as well as postcoital dysuria, genital dryness and pruritus of variable acuteness. She had no medical-surgical history of interest. She was nonsmoker and did not have any other toxic habits. Among her gyneco-obstetric records, it was stated that the patient was normorrheic, had a delivery by caesarean section and a stable partner for 22 years and presented as secondary sterility. She had come to the clinic for the same reason several times, showing no improvement to the different prescribed treatments: anti-inflammatory drugs, cicatrizant and hydrating creams, lubricants, topical estrogens, topical antifungal medication and probiotics. Physical and colposcopic examination revealed a normal vulva and a vagina with a moderate quantity of yellowish discharge of unspecific characteristics. In the vaginal sidewalls several over-raised erythematous patches of small size were observed in the lower third part and introitus. The cervix and the rest of the genital tract did not reveal any other pathological findings (Figure 1). We performed the following complementary tests:• A vulvovaginal culture, resulting negative.• The vaginal pH was over 4.5.• A cervical cytology that did not show any evidence of dysplasia. The polymerase chain reaction (PCR) for the Human Papilloma virus was negative.• A vaginal biopsy which was reported as a mucous with superficial ulceration and acute unspecific chronic inflammation (follicular) with no significant dysplasia or malignancy. There were no findings with PAS staining (Figure 2). AbstractIntroduction: Desquamative inflammatory vaginitis (DIV) is a chronic inflammatory process of unknown etiology, characterized by genital pain and profuse vaginal discharge, mainly affecting perimenopausal women. It is an entity little known by clinicians, leading to a delay in diagnosis and the consequent alteration of the patients' quality of life. The aim in this manuscript is to analyze DIV through the review of a case and the scientific literature. Case presentation: We report the case of a 40-year-old woman who presented this clinical profile for several years, being misdiagnosed as more ...
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