Description

Lipschütz ulcer is a rare condition characterised by the rapid onset of vulvar painful necrotic ulcerations. It typically occurs in sexually inactive girls and may be preceded by influenza-like symptoms. The aetiology is unknown, although recent reports have associated it with acute Epstein-Barr virus infection. The diagnosis is clinical, after ruling out other causes of genital ulcerations such as sexually transmitted and autoimmune diseases and trauma.1–3 We report a case of a healthy 13-year-old girl who developed flu-like symptoms and painful vulvar oedema (figure 1) followed by the appearance of labia minora ulcers (figure 2), without other mucosal or skin lesions. Complementary examinations were negative for microbial or autoimmune aetiology; there was no history of trauma, sexual activity or abuse. Herpes simplex virus testing (HSV PCR skin swab and HSV-type specific serology), Epstein-Barr virus, syphilis and HIV serology were negative. Symptomatic treatment was performed with topical and systemic analgaesia. Lesions healed in 6 weeks with no sequelae or recurrences. This case represents a rare differential diagnosis of genital ulceration, with an exuberant clinical presentation, often requiring hospitalisation for pain control and yet with good prognosis.

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Figure 1

Initial presentation with vulvar oedema.

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Figure 2

Acute ulceration of the labia minora with a symmetrical appearance (‘kissing pattern’).