Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature

Carriero Carmine; Schonauer Luca Maria; Loverro Giuseppe

doi:doi:10.11648/j.jgo.20150306.11

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Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature

Carriero Carmine, Schonauer Luca Maria, Loverro Giuseppe

Published in Journal of Gynecology and Obstetrics (Volume 3, Issue 6)

Received: 30 September 2015 Accepted: 16 October 2015 Published: 28 October 2015

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Abstract

Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.

Published in	Journal of Gynecology and Obstetrics (Volume 3, Issue 6)
DOI	10.11648/j.jgo.20150306.11
Page(s)	107-110
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Vulva, Ulcus Vulvae Acutum, Lipschutz Ulcer, Recurrence, Varicella Zoster Virus

References

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[17]	Brown ZA, Stenchever MA. Genital ulceration and infectious mononucleosis: report of a case. Am J Obstet Gynecol 1977; 127: 673–674.
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APA Style

Carriero Carmine, Schonauer Luca Maria, Loverro Giuseppe. (2015). Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. Journal of Gynecology and Obstetrics, 3(6), 107-110. https://doi.org/10.11648/j.jgo.20150306.11

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ACS Style

Carriero Carmine; Schonauer Luca Maria; Loverro Giuseppe. Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. J. Gynecol. Obstet. 2015, 3(6), 107-110. doi: 10.11648/j.jgo.20150306.11

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AMA Style

Carriero Carmine, Schonauer Luca Maria, Loverro Giuseppe. Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. J Gynecol Obstet. 2015;3(6):107-110. doi: 10.11648/j.jgo.20150306.11

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@article{10.11648/j.jgo.20150306.11,
  author = {Carriero Carmine and Schonauer Luca Maria and Loverro Giuseppe},
  title = {Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {3},
  number = {6},
  pages = {107-110},
  doi = {10.11648/j.jgo.20150306.11},
  url = {https://doi.org/10.11648/j.jgo.20150306.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20150306.11},
  abstract = {Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.},
 year = {2015}
}

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TY  - JOUR
T1  - Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature
AU  - Carriero Carmine
AU  - Schonauer Luca Maria
AU  - Loverro Giuseppe
Y1  - 2015/10/28
PY  - 2015
N1  - https://doi.org/10.11648/j.jgo.20150306.11
DO  - 10.11648/j.jgo.20150306.11
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 107
EP  - 110
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20150306.11
AB  - Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.
VL  - 3
IS  - 6
ER  -

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Author Information

Carriero Carmine

Dept. of Biomedical Sciences and Human Oncology, Section Gynaecology, University of Bari, Bari (Italy).
Schonauer Luca Maria

Dept. of Biomedical Sciences and Human Oncology, Section Gynaecology, University of Bari, Bari (Italy).
Loverro Giuseppe

Dept. of Biomedical Sciences and Human Oncology, Section Gynaecology, University of Bari, Bari (Italy).

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APA Style

Carriero Carmine, Schonauer Luca Maria, Loverro Giuseppe. (2015). Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. Journal of Gynecology and Obstetrics, 3(6), 107-110. https://doi.org/10.11648/j.jgo.20150306.11

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ACS Style

Carriero Carmine; Schonauer Luca Maria; Loverro Giuseppe. Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. J. Gynecol. Obstet. 2015, 3(6), 107-110. doi: 10.11648/j.jgo.20150306.11

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AMA Style

Carriero Carmine, Schonauer Luca Maria, Loverro Giuseppe. Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature. J Gynecol Obstet. 2015;3(6):107-110. doi: 10.11648/j.jgo.20150306.11

Copy | Download

@article{10.11648/j.jgo.20150306.11,
  author = {Carriero Carmine and Schonauer Luca Maria and Loverro Giuseppe},
  title = {Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {3},
  number = {6},
  pages = {107-110},
  doi = {10.11648/j.jgo.20150306.11},
  url = {https://doi.org/10.11648/j.jgo.20150306.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20150306.11},
  abstract = {Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.},
 year = {2015}
}

Copy | Download

TY  - JOUR
T1  - Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature
AU  - Carriero Carmine
AU  - Schonauer Luca Maria
AU  - Loverro Giuseppe
Y1  - 2015/10/28
PY  - 2015
N1  - https://doi.org/10.11648/j.jgo.20150306.11
DO  - 10.11648/j.jgo.20150306.11
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 107
EP  - 110
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20150306.11
AB  - Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.
VL  - 3
IS  - 6
ER  -

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