CASE DESCRIPTION
We report a healthy 17 year old adolescent who noted flu-like symptoms and the appearance of painful vulvar lesions associated with pruritus and dysuria.
Physical examination revealed multiple, painful ulcers located on the medial side of both labia minora (Figure 1).
A nasopharyngeal swab test was positive for SARS-CoV-2. PCR assay was negative for Herpes Simplex virus. Tests for Chlamydia trachomatis and Neisseria gonorrhoeae were negative.Urinalysis revealed no evidence of infection. Serologic tests were negative for EBV, CMV, syphilis, HIV and Mycoplasma pneumonae . International Criteria for Behçet´s Disease were applied and this disease was excluded. The patient was treated with oral anti-inflammatory drugs and topical lidocaine. 2 weeks later she was asymptomatic and with complete resolution of the vulvar ulceration.
After all investigation, SARS-CoV-2 infection was considered the trigger event for the appearance of the acute vulvar ulcers.
LU are rare entities characterized by a sudden onset of necrotic and painful genital ulcers, which occur mostly in non-sexually active young women. The mechanism responsible for this lesions is still unknown, but it is thought that it is associated with an underlying infectious disease. EBV is noted to be the most cited infectious etiology.[1,2]
A final diagnosis of LU related to SARS-CoV-2 is only possible after excluding other causes for these type of vulvar pathology.[2] With the emergence of the pandemic, a new infectious etiology should be considered when approaching vulvar ulcers. Clinical cases like this alert to possible associated conditions to SARS-CoV-2 infection, leading us to know this new coronavirus better and better.