10.5826/dpc.1301a54
text/xml
2160-9381
2568
en
Zoe Apalla
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Vulvar Aphthous Ulcer in an Adolescent Girl Suffering From COVID-19 Infection
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-04-30
2023-01-31
2023-03-01
e2023054
Dermatol Pract Concept
Zoe Apalla
2023/01/31
10.5826/dpc.1301a54
e2023054
Aristotle University of Thessaloniki, Faculty of Health Sciences, Second Department of Dermatology-Venereology, Larisa, Greece
2160-9381
en
e2023054
Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep. 2021;14(5):e242653. DOI: 10.1136/bcr-2021-242653. PMID: 33952571. PMCID: PMC8103359.
Vulvar Aphthous Ulcer in an Adolescent Girl Suffering From COVID-19 Infection
https://dpcj.org/index.php/dpc/article/download/2568/1925
           Vulvar Aphthous Ulcer in an Adolescent Girl
               Suffering From COVID-19 Infection
                             Christina Fotiadou1, Elizabeth Lazaridou1, Zoe Apalla1


1 Aristotle University of Thessaloniki, Faculty of Health Sciences, Second Department of Dermatology-Venereology, Larisa, Greece



Citation: Fotiadou C, Lazaridou E, Apalla Z. Vulvar Aphthous Ulcer in an Adolescent Girl Suffering From COVID-19 Infection. Dermatol
Pract Concept. 2023;13(1):e2023054. DOI: https://doi.org/10.5826/dpc.1301a54
Accepted: July 10, 2022; Published: January 2023
Copyright: ©2023 Fotiadou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Christina Fotiadou, MD, PhD, Aristotle University of Thessaloniki, Faculty of Health Sciences, Second Department
of Dermatology-Venereology, 1 Chrysochoou st, 41221, Larisa, Greece, E-mail: christinafotiadou@yahoo.com




Case Presentation                                                        Teaching Point
A 15-year-old girl presented with a two-day-history of                   Acute genital aphthous ulcers (AGU) or Lipschutz ulcers
a painful vulvar lesion. Clinical examination revealed a                 represent a rare, painful and distressing condition that
well-demarcated ulcer (2 cm) with a fibrinous center located             commonly affects sexually inactive adolescent girls.[1]
on the left minor labia (Figure 1). There was a second smaller           Although AGUs are considered an idiopathic condition,
ulcer opposite to the large one imitating a “kissing pattern”.           they have also been linked to several infections, autoim-
Both developed simultaneously. Regional lymph nodes were                 mune conditions and topical trauma. COVID-19, on the
unaffected (no pain, no oedema). She suffered from mild sys-             other hand, has been linked to several cutaneous mani-
temic symptoms (low fever and rhinorrhea) and was tested                 festations (among which the reactivation of herpes zos-
positive for COVID-19 (Polymerase Chain Reaction test-PCR)               ter) but its relationship with AGU is still poorly clarified.
three days before the appearance of the ulcer. The patient was           [1] The most common infections, which are temporally
not under treatment for Severe Acute Respiratory Syndrome                associated with AGU, are those caused by Ebstein-Barr
Coronavirus 2 (SARS-CoV-2) or for any other disease. Per-                and Cytomegalovirus viruses and in a lesser extent by in-
sonal and family history for previous oral or vulvar aphthosis,          fluenza and mumps viruses, as well as salomonella and
as well as for inflammatory bowel or other autoimmune dis-               mucoplasma. The underlying mechanism in these cases is
eases, was negative. The patient had no history of prior sexual          probably a dysregulation of the immune system with cyto-
activity and serological tests for Epstein Barr, Cytomegalovi-           kine activation due to systemic illness. The fact that Sars –
rus and Syphilis were also negative. The prescribed treatment            Cov-2 virus causes a systemic autoimmune inflammatory
included a mid-potency topical steroid twice daily. The ulcers           response which affects multiple organ systems could be
healed within 10 days. Both the parents and the patient gave             the link between the development of aphthous ulcers and
consent to publish images of the lesion.                                 COVID infection.[2]




Image Letter | Dermatol Pract Concept. 2023;13(1):e2023054                                                                           1
       Figure 1. Aphthous ulcer located on the left labia minora of a 15-year-old girl suffering from COVID-19. The ulcer has
       well-demarcated borders, erythematous background and fibrinous center.




References:                                                            2. Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually ­related
                                                                          acute genital ulcers associated with COVID-19. BMJ Case Rep.
1. Vismara SA, Lava SAG, Kottanattu L, et al. Lipschütz’s acute vul-      2021;14(5):e242653. DOI: 10.1136/bcr-2021-242653. PMID:
   var ulcer: a systematic review. Eur J Pediatr. 2020;179(10):1559-      33952571. PMCID: PMC8103359.
   1567. DOI: 10.1007/s00431-020-03647-y. PMID: 32296983.




2                                                                            Image Letter | Dermatol Pract Concept. 2023;13(1):e2023054
