Desquamative Inflammatory Vaginitis as an Extraintestinal Manifestation of Crohn’s Disease

Shukla, Asmita; Surapaneni, Sarvani; Sobel, Jack D.

doi:10.1007/s11908-020-00733-y

Cited by 1 publication

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“…Although most women with DIV have no other clinical manifestations or complications outside the lower genital tract, multiple case reports of DIV complicating autoinflammatory Crohn disease and rheumatoid arthritis are described. 16 In a previous article by Sobel et al, 7 in which 200 cases of DIV were reported, no other autoimmune conditions were observed. Although rare, SLE should be added to this list of autoinflammatory diseases as an associated entity.…”

Section: Discussionmentioning

confidence: 90%

“…It was only after controlling her SLE symptoms with systemic steroids that we observed improvement and eradication of her vaginal disease. Although most women with DIV have no other clinical manifestations or complications outside the lower genital tract, multiple case reports of DIV complicating autoinflammatory Crohn disease and rheumatoid arthritis are described 16 . In a previous article by Sobel et al, 7 in which 200 cases of DIV were reported, no other autoimmune conditions were observed.…”

Section: Discussionmentioning

confidence: 98%

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Desquamative Inflammatory Vaginitis as an Expression of Systemic Lupus Erythematosus

Vempati

Sobel

2022

J Low Genit Tract Dis

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S ystemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with various systemic manifestations. Genital manifestations of SLE involving the vulva are characterized by whitish atrophic plaques and painful erosions in the introitus. [1][2][3][4][5] There are only a few reports of vulvar involvement but no reports of vaginal involvement in SLE. 5,6 Prevalence of SLE among women of reproductive age is postulated to be the result of estrogen on the immune system. 1,4 Grimaldi and colleagues 2,3 have demonstrated that estrogen plays a crucial role in B-cell maturation, selection, and activation, potentially causing the breakdown of immune tolerance seen in SLE.Desquamative inflammatory vaginitis (DIV), an autoinflammatory form of vaginitis, presents with a purulent vaginal discharge, burning sensation, vestibular-vaginal irritation, and dyspareunia. [7][8][9] Diagnostic criteria for DIV include vaginal inflammation (spotted ecchymotic rash, diffuse erythema, and focal or linear erosion), a vaginal pH level greater than 4.5, and saline microscopy showing increased numbers of parabasal cells (immature epithelial cells), polymorphonuclear inflammatory cells, and dysbiosis. Desquamative inflammatory vaginitis is a diagnosis of exclusion, and other causes of purulent vaginitis should be excluded. The differential diagnosis includes trichomoniasis, Candida vaginitis, atrophic vaginitis, and erosive disorders, such as erosive lichen planus, pemphigus vulgaris, and cicatricial pemphigoid. 9,10 Desquamative inflammatory vaginitis has been reported in association with other systemic immune-mediated conditions, and there are no previous studies documenting the association between DIVand SLE. We report a case of chronic DIV in a young African American woman with a known history of SLE. She met all the criteria for DIV and had concomitant SLE flares with recurrent pregnancies. Her symptoms were resistant to standard DIV treatment, and only after controlling SLE with systemic steroids did her vaginal symptoms subside.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%