Ulcus vulvae acutum - A rare case
Background: Ulcus vulvae acutum, also known as Lipschütz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy.
Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of Behçet’s. The patient was treated with a combination of 2.5% lidocaine and 2.5% prilocaine creams for 1 week, 2% fusidic acid ointment for 1 week, with no significant progression. Later, the therapy was changed to 0.05% clobetasol propionate ointment for 10 days. Complete healing occurred in about 10 weeks with no scarring.
Discussion: Diagnosis of ulcus vulvae acutum in this patient was made by excluding other differential diagnoses.
Conclusion: Ulcus vulvae acutum is a difficult diagnosis, and clinician should be aware of this entity especially when encountering young woman without previous sexual experience problem with ulcer.
Keywords: ulcus vulvae acutum, genital ulcer, young women
1. Govindan B. Lipschütz ulcers: A literature review based on 79 cases. EMJ Repro Health. 2016;2(1):73-8.
2. Huppert JS. Lipschütz ulcers: Evaluation and management of acute genital ulcers in women. Dermatol Ther. 2010;23:533-40.
3. Visentin D, Driul L, Buligan C, et al. Ulcus vulvae acutum – A case of genital ulcers in adolescent girl. Case Reports in Women’s Health. 2016;9:4-6.
4. Trčko K, Belič M, Miljkovič. Ulcus vulvae acutum. Acta Dermatoven APA. 2007;16(4):174-6.
5. Bhat RM, Furtado S. Lipschütz ulcer. Indian J Sex Transm Dis. 2007;28(2):106-7.
6. Tőrők L, Domjăn K, Faragŏ E. Ulcus vulvae acutum. Acta Dermatoven APA. 2000;9(1):30-3.
7. Kinyŏ A, Nagy N, Olăh J, Kemĕny L, Csőrgő ZB. Ulcus vulvae acutum Lipschütz in two young female patients. Eur J Dermatol. 2014;24(3):361-4.
8. Sardy M, Wollenberg A, Niedermeier A, Flaig MJ. Genital ulcers associated with Epstein-Barr virus infection (ulcus vulvae acutum). Acta Derm Venereol. 2011;91:55-9.
9. Mourinha V, Costa S, Urzal C, Guerreiro F. Lipschütz ulcer: Uncommon diagnosis of vulvar ulcerations. BMJ Case Rep. 2016:1-2.
10. Brinca A, Canelas MM, Carvalho MJ, Vieira R, Figueiredo A. Lipschütz ulcer (ulcus vulvae acutum) – A rare cause of genital lesion. An Bras Dermatol. 2012;87(4):622-4.
11. Zouboulis CC. Adamantiades-Behcet disease. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine. 8th edition. New York: Mc Graw Hill; 2012:2033-42.
12. Viera-Baptista P, Silva JL, Beires J, Oliveira JM. Lipschütz ulcers: Should we rethink this? An analysis of 33 cases. Eur J Obstet Gynecol Reprod Biol. 2016;198:149-52.
13. Edwars L, Lynch PJ. Erosion and Ulcers. In: Edwards L, Lynch PJ. Genital Dermatology Atlas and Manual. 3th edition. Philadelphia: Wolters Kluwer; 2017.