Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion

Abstract

Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration. Keywords: Genital diseases, female; Infectious mononucleosis; Ulcer Resumo: A Úlcera de Lipschütz, ou ulcus vulvae acutum, é uma entidade rara mas provavelmente subdiagnosticada, que se apresenta como úlcera vulvar aguda dolorosa numa mulher jovem. A etiologia é desconhecida embora relatos recentes a tenham associado à primo-infecção pelo vírus Epstein-Barr. O diagnóstico é estabelecido após exclusão de doenças sexualmente transmissíveis, causas autoimunes, traumáticas e outras etiologias de úlceras genitais. Relatamos o caso de uma jovem que desenvolveu quadro gripal e dolorosas úlceras genitais. Os exames complementares excluiram doenças sexualmente transmissíveis e as outras causas habituais de ulceração genital. As lesões cicatrizaram sem sequelas e sem recorrências. Este caso representa um diagnóstico diferencial importante e raro de ulceração genital. Palavras-chave: Doenças dos genitais femininos; Mononucleose infecciosa; Úlcera

Lymphocytic Arteritis in Epstein–Barr Virus Vulvar Ulceration (Lipschütz Disease)

“…Mostly, 59% had acute EBV infection, 2,[10][11][12][13][14]16,[18][19][20]23,25,27 and 32% had a coexisting acute systemic viral illness, not otherwise specified. 17,21,22,24,26 Aphthosis (4%) 9 and CMV infection (4%) 15 were other reported etiologies.…”

“…17,27 Vasculitis was identified in 35%, 16,17,19,20,23,24,27 mostly classified as leukocytoclastic vasculitis, 16,17,19,27 or lymphocytic vasculitis in 5%. 20 Figures from 3 reports showed evidence of vasculitis, 23,24,27 and another figure showed evidence of reactive angioendotheliomatosis; a pattern that is associated with either vaso-occlusive or vasculitic insult. 15,31,32 Neutrophilic rich/predominate infiltrates (44%) [11][12][13]27 or mixed dense neutrophilic and lymphocytic infiltrates (26%) 2,14,19,20,22-24 were often described as pustular or necrotizing.…”

“…Finally, we review reports documenting the histopathology of vulvar biopsies from women biopsied during evaluation of painful vulvar ulcers. 2,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] MATERIAL AND METHODS…”

Lipschütz ulcer: a rare diagnosis to keep in mind

“…The histological aspect is not specific [5,6]. The diagnosis of Lipschütz ulcer remains a diagnosis of elimination often carried retrospectively, in front of a spontaneously and rapidly resolving evolution without subsequent recurrences.…”

“…The diagnosis of Lipschütz ulcer remains a diagnosis of elimination often carried retrospectively, in front of a spontaneously and rapidly resolving evolution without subsequent recurrences. However, it is imperative to rule out other causes of more frequent genital ulcers, particularly a sexually transmitted disease, and to discuss the main differential diagnoses such as Behçet's disease, idiopathic aphtosis or cutaneous localization of Crohn's disease [2][3][4][5][6].…”