Lipschütz ulcer: case report and literature review

Background
Genital ulcers are an unusual complaint in pediatrics. Most are caused by sexually transmitted infections (STIs), although there are non-venereal etiologies that should also be considered. Lipschütz ulcers are a rare and frequently underdiagnosed cause of non-infectious genital ulcers, which are usually preceded by a viral trigger and have a self-limiting course.

Case report
A 17-year-old female patient presented with an acute vulvar lesion, accompanied by complaints of malaise, fever and odynophagia. She was sexually active. On examination, she had bilateral tonsillar exudates, hepatomegaly and a painful, well-limited vulvar ulcer. Complementary exams ruled out most common STIs, and the Paul-Bunnel test was positive. Treatment was supportive. Based on the clinical presentation and laboratory results, the diagnosis of a Lipschütz ulcer, in the context of acute mononucleosis, was made. Three weeks after the initial presentation, the lesion was fully healed. The case was entirely managed in ambulatory care.

Conclusions
This case represents a rare but important differential diagnosis of genital ulceration. The prompt suspicion of a Lipschütz ulcer spared the patient from unnecessary exams and therapies. It should be noted that this disease mainly affects young adolescents, for whom the disclosure of its symptoms might be challenging. A trusting doctor–patient relationship is fundamental to ensure proper management and follow-up.