The New England Journal of MedicineLipschütz’s Ulcer

Epstein-Barr Virus Linked to Non-Sexually Transmitted Acute Genital Ulcers in Young Woman

A case report of a 17-year-old girl presenting with painful genital ulcers highlights the importance of recognizing Lipschütz’s ulcers as a differential diagnosis in adolescent females. This condition, characterized by non-sexually transmitted acute genital ulcerations, typically occurs following a viral illness such as Epstein-Barr virus (EBV) infection. Clinicians could consider this diagnosis after ruling out sexually transmitted infections, particularly in young patients with no history of sexual activity.

Key Points:

• Patient: Previously healthy 17-year-old girl
• Presenting symptom: 7-day history of painful genital ulcers
• Prior illness: 7-day episode of fever, malaise, and sore throat ending 8 days before ulcer onset
• Sexual history: No reported sexual activity
• Physical examination: Two necrotic ulcers (3.5-4.0 cm diameter) on opposing sides of labia minora
• Laboratory results:
  • Negative for sexually transmitted infections and pregnancy
  • Serologic testing positive for acute EBV infection
• Diagnosis: Lipschütz’s ulcers
• Characteristics of Lipschütz’s ulcers:
  • Non-sexually transmitted acute genital ulcerations
  • Most common in teenage girls or young women
  • Typically manifest as deep, painful ulcers
  • Often occur after a viral illness, such as acute EBV infection
• Diagnostic approach:
  • Clinical diagnosis
  • Rule out alternative causes, especially sexually transmitted infections
• Prognosis:
  • Self-limited condition
  • Most cases do not recur
• Treatment options:
  • Topical and oral glucocorticoids may hasten resolution
  • In this case: reassurance, topical lidocaine, and oral analgesic agents
• Outcome: Ulcers resolved in 6 weeks

In a 2009 JAMA Dermatology study, researchers presented a series of 13 consecutive cases of acute genital ulcers (AGU) in female patients younger than 20 years, and they showed that one-third of these AGUs were associated with EBV primary infection.

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