Lipschutz ulcer: a diagnosis to keep in mind

Lipschütz ulcer is an uncommon entity known as acute reactive genital ulcer not related to sexual intercourse, that affects mainly adolescents and young women.¹ It usually has an abrupt onset and is characterized by severe local pain and dysuria. A prodromal phase of viral symptoms such as fever, fatigue and malaise is frequent.²
Although its etiology and pathogenesis are still unknown, a reactive process triggered by an infection is hypothesized, due to the deposition of immune complexes in the dermal vessels, causing microthrombosis and deep, necrotizing, painful ulcers.³ Cytomegalovirus, EBV, influenza, Salmonella and Mycoplasma have been associated with this entity. More recently, acute genital ulcers were reported following SARS-CoV-2 infection and vaccination.^4,5 Differential diagnoses include venereal ulcers (e.g. herpes simplex virus, HIV and syphilis), autoimmune diseases (e.g. Behçet's disease, Crohn's disease, pyoderma gangrenosum and vulvar pemphigoid), trauma and malignant tumors.^5,6 Diagnosis is made by exclusion. Treatment is mainly symptomatic with topical anesthetic and corticosteroids, with spontaneous cure in 2 to 6 weeks and rare recurrences.⁵
With this clinical case we want to highlight the importance of considering this diagnosis, since acute genital ulcers in a young adolescent can distress both patients, families and healthcare professionals.

References :

Polito A, Morley C. Lipschutz Ulcers: A Rare, but Important Diagnosis in Young Females Presenting with Acute Genital Ulcerations. Pediatrics 2022; 149: 602-602. Vismara SA, Lava SAG, Kottanattu L, et al. Lipschütz's acute vulvar ulcer: a systematic review. Eur J Pediatr 2020; 179: 1559-1567. Koliou MG, Kakourou T, Richter J, et al. Mycoplasma pneumoniae as a cause of vulvar ulcers in a non-sexually active girl: a case report. J Med Case Rep 2017; 11: 187. Hsu T, Sink JR, Alaniz VI, et al. Acute Genital Ulceration After Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination and Infection. J Pediatr 2022; 246: 271-273. Wojcicki AV, O'Flynn O'Brien KL. Vulvar Aphthous Ulcer in an Adolescent After Pfizer-BioNTech (BNT162b2) COVID-19 Vaccination. J Pediatr Adolesc Gynecol 2022; 35: 167-170. Schafer F, Miranda R. Acute genital ulcers in a young girl: a clinical challenge: Lipschütz ulcer. An Bras Dermatol 2022; 97: 682-683.