Lipschütz ulcer and group A streptococcal tonsillitis

Limão, Sara; Ventura, Ana; Queirós, Gustavo; Cunha, Florbela

doi:10.1136/bcr-2017-223579

Cited by 8 publications

(3 citation statements)

References 15 publications

(5 reference statements)

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“…If aphthous ulcers are suspected, further testing for Epstein-Barr virus, 5–7 cytomegalovirus, 8–10 and Mycoplasma pneumoniae 11–13 can be performed 5 . In 30% of cases, acute aphthous ulcers can be also be associated with other infections such as group A streptococcus, 14 influenza A, 15 parvovirus, 2,5 paramyxovirus, 16 salmonella, 17 toxoplasmosis, 18 mumps, 16 Lyme disease, 19 and coronavirus disease (COVID-19) 20–23 . It is important to remember that aphthous ulcers may be a skin response to any virus, even those not listed here.…”

Section: Diagnosismentioning

confidence: 99%

Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment

Saunders,

Welch,

Haefner

et al. 2023

J Low Genit Tract Dis

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Objectives Vulvar ulcers can be challenging to diagnose, manage, and treat. Ulcers can be nonspecific in appearance and have many etiologies. Description of the lesion is very important. Methods An interactive vulvar ulcer algorithm was created to aid in the evaluation, diagnosis, and treatment of vulvar ulcers Results The algorithm flowchart begins with careful history and physical examination. Pending these, specific tests can be obtained to aid in diagnosis. The algorithm also links to appropriate treatments. The algorithm can be accessed on the International Society for the Study of Vulvovaginal Disease Web site (issvd.org). Each underlined word in the algorithm is a hyperlink that leads to a wealth of information on the topic that providers can use to direct testing and aid in diagnosis and treatment. Conclusions The vulvar ulcer algorithm can help clinicians with diagnosis and treatment plans.

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Section: Diagnosismentioning

confidence: 99%

Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment

Saunders,

Welch,

Haefner

et al. 2023

J Low Genit Tract Dis

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“…EBV is the most common infectious disease associated with genital ulcers and EBV DNA is frequently detected in genital lesions (2). Other viruses and bacteria are rarely detected(2), like CMV, Mycoplasma species(6), Influenza, Mumps, Paratyphoid fever, Streptococcal pharyngitis (7) and murine typhus (8). With the emergence of the pandemic of the new Coronavirus Sars-Cov2, related cases of Lipschütz's ulcer have also been reported.…”

Section: Etiologymentioning

confidence: 99%

Fever and Vulvar Ulcers in an Adolescent Girl: A Diagnosis of Lipschütz’s Ulcer Associated with EBV and SARS Cov-2 Infection

2022

Ann Case Report

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Introduction: Genital ulcers are rare in pediatric age; they affect predominantly adolescents, causing concern and discomfort in the patients and their families. We report the case of a 14-years-old girl who came to our Emergency Department (ED) for vulvar ulcers and fever. Case description: A 14-years-old girl presented to our ED for a 5-day fever associated with a vulvar ulcer, malaise, dysuria with urinary retention. She had started oral acyclovir and amoxicillin-clavulanate two days before. Five months before she presented a similar episode. She denied any kind of sexual contact or trauma. Physical examination revealed a deep and painful ulcer of about 1.5 cm in diameter on the left minor labium, covered with fibrin, necrotic tissue, and purulent exudate. Specularly, on the inner right lip there was a small superficial ulcer of 3 mm in diameter. She had hyperemic pharynx, bilateral laterocervical and inguinal polyadenopathy. Blood tests showed increase in blood lymphomonocytes, inflammatory markers and transaminases; the pharyngeal antigenic swab for SARS-CoV2 was positive. EBV serology was compatible with acute primary infection. Serology for CMV, HSV 1-2 and Treponema, ANA, Rheumatoid factor, C3, C4, IgA, IgG, IgM, lymphocyte subpopulations, HLA-B5, B51, B27 and thyroid function tests were normal. Anti thyroid peroxidase and anti TSH receptor antibodies were positive. On the ulceral swab, PCR was positive for EBV and negative for HSV 1-2, CMV and SARS-CoV-2. Vulvar swab culture detected the presence of Escherichia coli, Enterococcus faecalis and Candida albicans. Fundus oculi and pathergy test were negative. A Lipschütz's ulcer during primary infection of EBV in concomitant SARS-CoV2 infection was suspected. The ulcers were treated with impregnated gauzes and hygiene. Antibiotic therapy was continued, and fluconazole was added, given the bacterial superinfection of the ulcer. Oral acyclovir was discontinued. Urinary catheter was kept in place until disappearance of dysuria (4 days). Multidisciplinary approach was required. Fever disappeared on the 11th day after disease onset. Vulvar ulcers completely healed in three weeks. The girl was referred to the Immuno-rheumatologically Center for follow up. Discussion: Genital ulcers in adolescents are most commonly referred to sexually transmitted infections, causing embarrassment and possibly compromising communication between the young patient and the doctors. However, vulvar ulcers can be caused by other conditions: our case shows that Lipschütz Ulcer, an unusual diagnosis in Pediatric ED, should not be neglected and has to be suspected in presence of a concomitant viral infection. It remains a diagnosis of exclusion: if episodes recur, careful follow-up is needed to rule out other causes, such as autoimmune or auto inflammatory diseases.

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“…Since 1949, association between Lipschütz genital ulcer and different kinds of systemic infections has been reported, mostly viral origins like Epstein–Barr virus (EBV), cytomegalovirus (CMV), mumps viruses, influenza virus and adenovirus, but also bacterial like Mycoplasma pneumoniae , group A streptococcus and Salmonella enterica (paratyphoid fever) . The infectious association is mainly observed in adolescents with the first type of painful non‐recurrent ulcers.…”

Section: Pathogenesismentioning

confidence: 99%

Lipschütz genital ulcer revisited: is juvenile gangrenous vasculitis of the scrotum the male counterpart?

Chen

Plewig

2019

Acad Dermatol Venereol

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Since its first description as ulcus vulvae acutum by Benjamin Lipschütz in 1912, the etiopathogenesis of this peculiar genital ulcer remains incompletely understood. In his original description, two different types of genital ulcers were observed and proposed, which were not precisely defined and distinguished in most subsequent reports. The first type is characterized by acute excruciating genital ulcers of first‐time onset with self‐limited non‐recurrent course in association with gravely symptomatic systemic infections, in which a primary Epstein–Barr virus (EBV) infection is later identified to be probably the most common aetiology. The second type of ulcer usually refers to little painful ulcers of unknown etiopathogenesis in the absence of fever or chills and with a slow torpid progression and recurrent nature. Differentiation from idiopathic aphthous ulcers is unclear. The changes of the cervicovaginal microbiota and microbiome in diseased state deserve further clarification. Acute genital ulcers associated with primary EBV infection in women have drawn attention since 1970s, while the corresponding penile ulcers in men were already known in 1950s. First presented in 1973, juvenile gangrenous vasculitis of the scrotum with an acute painful scrotal ulcer preceded by symptomatic pharyngeal infections can be considered as the male counterpart of ulcus vulvae acutum, and the future clinical survey should include primary EBV infection.

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Lipschütz ulcer and group A streptococcal tonsillitis

Cited by 8 publications

References 15 publications

Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment

Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment

Fever and Vulvar Ulcers in an Adolescent Girl: A Diagnosis of Lipschütz’s Ulcer Associated with EBV and SARS Cov-2 Infection

Lipschütz genital ulcer revisited: is juvenile gangrenous vasculitis of the scrotum the male counterpart?

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