Disseminated Lyme Disease Presenting With Nonsexual Acute Genital Ulcers

Abstract

Although the etiology of NAGU is unknown, the vulvar ulcers may result from an exuberant immune response to infection. Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen. In addition to previously reported associations with systemic infection, which are reviewed herein, Lyme disease should be considered in women presenting with acute-onset genital ulcers.

Epstein-Barr Virus-related Acute Genital Ulcer Successfully Treated with Colchicine

“…The association of some cases of AGU with EBV infection was suggested in 1977 and, since then, approximately 40 EBV-linked cases have been reported, mostly during primary infection or unspecified EBV infection (4), the involvement of EBV being reported in approximately 30% of AGU (1). Other infectious agents have also been involved in some cases, including CMV (7), Toxoplasma gondii, Mycoplasma pneumonia (6), Streptococcus spp, Salmonella enterica (8), mumps, influenza A and B virus, adenovirus (9), and Borrelia burgdorferi (10).…”

Vulvar infections: beyond sexually transmitted infections

“…This condition, which became known as Lipschütz's ulcer or ulcus vulvae acutum, has been recognized as a reactive phenomenon to various acute illnesses and is covered with the umbrella term of RNSRAGU. RNSRAGU may present as a secondary phenomenon to viruses and other microbes, including: primary Epstein–Barr virus (EBV), cytomegalovirus (CMV), mycoplasma, influenza A, viral gastroenteritis, viral upper respiratory infection (URI), paratyphoid, mumps, and recently Lyme disease . In many cases, however, no clear etiology is found …”

Nonsexually acquired genital ulcers in a 79‐year‐old woman

“…Clinically, it presents with acute single or multiple ulcers, several millimeters to centimeters in size, with regular and sharply defined margins, surrounded by an erythematous halo and typically located in the medial aspects of the labia minora. In addition, the ulcers can be covered with an adherent dirty membrane . Inguinal lymphadenopathy is not always present upon palpation.…”

“…There is no consensus on the treatment but most reports suggest that it might be mainly symptomatic, using oral anti‐inflammatory agents, topical antiseptics, and topical antibiotics whether associated or not with oral corticoids and oral antibiotics if significant genital pain and edema are present …”

“…While the etiology of LU is still unknown, it has been related to EBV infection, CMV, measles, influenza, and even Lyme disease . It has also been suggested that airborne transmission of a viral infection could explain the development of acute genital ulcers, supported by two consecutive cases of LU presented in twin sisters …”