Images in Paediatrics
Lipschütz ulcer as a possible SARS-COV-2 manifestation
Úlcera de Lipschütz como posible manifestación del SARS-CoV-2
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dos Reis" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Joana" "apellidos" => "Ferreira Mendes" "email" => array:1 [ 0 => "joana.f.mendes@chedv.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sérgio" "apellidos" => "Alves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Isabel Pinheiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Joana" "apellidos" => "Soares dos Reis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Reumatología Pediátrica, Centro Materno Infantil do Norte, Oporto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera de Lipschütz como posible manifestación del SARS-CoV-2" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1205 "Ancho" => 755 "Tamanyo" => 99774 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0350" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exam at re-evaluation: clinical improvement and presence of a residual scar.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lipschütz ulcer is a rare and self-limited condition characterized by rapid onset of painful vulvar ulceration and more frequent in adolescent girls. It has been linked to infection and it is not associated with sexually transmitted infections (STIs).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A previously healthy and sexually inactive girl aged 11 years presented dysuria of 2 days’ duration resulting in urinary retention. She had been diagnosed with active SARS-CoV-2 infection 5 days before admission, accompanied by fever in the first 3 days and without any respiratory symptoms. The patient had no history of recurrent oral/genital ulcers nor a family history of Behçet or Crohn disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination revealed a full, distended bladder, 3 painful vulvar ulcers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and vaginal exudate. The hymen was intact.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Previous evidence suggests that acute genital ulcers can develop as a manifestation of primary infection by viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV) or, more recently, SARS-CoV-2. Testing excluded infection by CMV, EBV, adenoviruses and influenza A and B and STIs including infection by herpes simplex virus type 1/2, <span class="elsevierStyleItalic">Chlamydia trachomatis, Haemophilus ducreyi</span> and human immunodeficiency virus and syphilis. Lipschütz ulcer was suspected upon detection of SARS-CoV-2 by reverse transcription polymerase chain reaction in a nasopharyngeal swab sample.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was treated with topical fusidic acid and lidocaine 2%. At 10 days, she exhibited clinical improvement and had developed a residual scar (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Lipschütz ulcer should be considered in the differential diagnosis of painful vulvar ulceration.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There are a few cases reported in the literature in association with SARS-CoV-2 infection<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> or administration of the SARS-CoV-2 mRNA vaccine.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,6</span></a> Complete resolution is expected, and early treatment is essential to avoid complications like urinary retention.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1205 "Ancho" => 755 "Tamanyo" => 78096 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0345" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical examination at admission: 3 vulvar ulcers, the most prominent measuring 12<span class="elsevierStyleHsp" style=""></span>mm, with a purplish-red border and a deep, necrotic base in the left inner fold of the vulva, and the 2 smaller ulcers on the right (“kissing” lesions).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1205 "Ancho" => 755 "Tamanyo" => 99774 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0350" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exam at re-evaluation: clinical improvement and presence of a residual scar.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reactive non-sexually related acute genital ulcers associated with COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. 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Popatia" 1 => "Y.E. Chiu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatric Dermatol." "fecha" => "2022" "volumen" => "39" "paginaInicial" => "153" "paginaFinal" => "154" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipschütz ulcers after the AstraZeneca COVID-19 vaccine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. González-Romero" 1 => "V. Morillo Montañes" 2 => "I. Vicente Sánchez" 3 => "M. García García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Proceedings Dermosifiliogr." "fecha" => "2022" "volumen" => "113" "paginaInicial" => "S29" "paginaFinal" => "S31" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000002/v1_202402182114/S2341287923002594/v1_202402182114/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000002/v1_202402182114/S2341287923002594/v1_202402182114/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923002594?idApp=UINPBA00005H" ]
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