When It's Not a Sexually Transmitted Infection (STI): A Diagnostic Challenge of Severe Lipschütz Ulcer in a Young Woman

TL;DR

A young woman's severe genital ulcers were correctly diagnosed as Lipschütz ulcer, a rare non-STI condition, after initial misdiagnosis with herpetic ulcers.

Contribution

Highlights the diagnostic challenge and underrecognition of Lipschütz ulcer in young women with acute genital ulcers.

Findings

Lipschütz ulcer was diagnosed after ruling out infectious and inflammatory causes in a 21-year-old woman.

Supportive treatment with corticosteroids led to rapid recovery and symptom relief.

The case underscores the need for increased awareness to prevent misdiagnosis and unnecessary treatments.

Abstract

Genital ulcers are often attributed to sexually transmitted infections (STIs), yet a notable subset originates from non-venereal causes. Misdiagnosis can lead to unnecessary treatments, social stigma, and emotional distress. Lipschütz ulcer is a relatively uncommon, non-sexually transmitted condition characterized by the sudden appearance of painful, necrotic ulcers in the vulvar region. It predominantly affects adolescents and young women and is frequently underrecognized. Acute genital ulcers have been linked to infections such as Epstein-Barr virus (EBV) and other viral or bacterial pathogens, including SARS-CoV-2, and, rarely, can occur following SARS-CoV-2 vaccination, though the exact cause often remains unclear.

We present the case of a 21-year-old woman who developed severe vulvar ulceration and swelling over seven days, leading to urinary retention. While abroad, she was initially misdiagnosed with herpetic ulcers, but a brief prodromal febrile illness preceded lesion onset. Examination revealed bilateral "kissing" ulcers on the labia majora with irregular borders and a fibrinoid necrotic base. Careful evaluation ruled out infectious, inflammatory, and traumatic causes, including necrotizing fasciitis, infected herpetic lesions, and sexual assault. Correlating her clinical features led to the diagnosis of Lipschütz ulcer. Supportive management with corticosteroids resulted in rapid symptom relief and complete recovery.

This case emphasizes the importance of considering Lipschütz ulcer in young women presenting with sudden, painful genital ulcers, particularly following a febrile illness and in the absence of sexual exposure. Raising awareness among gynaecologists, general practitioners, dermatologists, and paediatricians can reduce misdiagnosis, prevent unnecessary interventions, and alleviate patient distress. Sharing such cases helps improve recognition and supports the development of standardized diagnostic and management strategies for this underdiagnosed condition.

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