Joana Pereira Mendes1,2, Leonor Luz Duarte3, Ana Cláudia Cavadas Almeida1, Ana Brett4,5
1Pediatrics Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal, 2Pediatrics Department, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal, 3Family Medicine Department, USF Caminho Novo, ACeS Espinho Gaia, Portugal, 4Emergency Department and Infectious Disease Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal, 5Clínica Universitária de Pediatria, Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
Address for Correspondence: Joana Pereira Mendes, Alameda Pêro da Covilhã, 6200-251 Covilhã, Portugal.
Email: joanapereiramendes92@gmail.com
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Question :A previously healthy 12-year-old girl, presented to the Emergency Department with fever, sore throat and painful vulvar lesions for the past two days. She denied sexual activity. Menarche was at 10 years of age.
Physical examination revealed edema and erythema of the left labia minora and an ulcerated necrotic lesion on both sides of labia minora, mimicking a “kissing pattern”, 15mm in diameter, with regular and well-circumscribed margins and an overlying grey exudate (Figures 1 and 2). She also had an infracentimetric left inguinal lymphadenopathy and enlarged tonsils with exudate. Serology confirmed acute Epstein-Barr virus (EBV) infection.
Figure 1. Edema of the left labia minora. 
Figure 2. Ulcerated and necrotic lesion with a “kissing pattern” and grey exudate, typical presentation of Lipschütz ulcer.  What is the diagnosis?
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