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
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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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