# Lipschütz Ulcers In 12-year-old Premenarchal Female Days After A Gastrointestinal Illness: A Case Report

## TL;DR

A 12-year-old girl developed Lipschütz ulcers, a rare immune reaction, after a gastrointestinal illness and was successfully treated with steroids and pain management.

## Contribution

This case report adds a rare clinical presentation of Lipschütz ulcers in a premenarchal female following a viral illness.

## Key findings

- The patient presented with vulvar swelling, pain, and vaginal discharge after a gastrointestinal illness.
- Diagnosis of Lipschütz ulcers was confirmed, and treatment with steroids and pain relief led to full recovery.
- The case highlights the importance of considering immune-mediated causes in premenarchal girls with genital ulcers.

## Abstract

Lipschütz ulcers are a rare immune-mediated reaction that commonly occurs in premenarchal females, usually associated with a recent viral illness.1 The treatment for Lipschütz ulcers consists of pain relief, topical steroids, and, in severe cases, a course of systemic steroids.1 A thorough history and exam, as well as an appropriate workup to rule out other causes of vaginal ulceration, should be completed.2

A premenarchal, 12-year-old female presented to the emergency department (ED) with her mother due to significant vulvar pain. Two days prior, the patient had a gastrointestinal illness associated with vomiting, diarrhea, and fever. On exam, she had significant swelling of the labia minor, discoloration with a necrotic appearance of the introitus, and brown vaginal discharge. The patient denied sexual intercourse, concern for retained vaginal foreign body, or vaginal trauma. Gynecology suggested the diagnosis of a rare post-viral immune-mediated reaction causing acute genital ulcerations, also known as Lipschütz ulcers. The patient’s treatment regimen included topical and systemic steroids, enteral opioid pain medication, and topical lidocaine. Her symptoms had resolved at her two-month follow-up visit.

In summary, this case report discusses a previously healthy 12-year-old premenarchal female who presented to the ED due to vulvar swelling, pain, and vaginal discharge in the setting of a recent viral gastrointestinal illness. The patient was seen in the ED by gynecology and diagnosed with Lipschütz ulcers. Lipschütz ulcers are an uncommon condition causing acute genital ulcers.