Akademik Veri Yönetim Sistemi
Cocuk Enfeksiyon Dergisi, cilt.18, sa.2, ss.109-113, 2024 (ESCI)
Ulcus vulvae acutum (UVA) was defined by Lipschütz and is also known as primary aphthous ulcer or non-sexually transmitted reactive acute genital ulcer. Its etiology is unknown. Diagnosis is made by excluding other infectious and non-infectious causes that may be responsible for vulvar ulcer. A 12-year-old female patient presented with a rapidly growing pustule-like lesion that appeared in the genital area four days ago, progressing with swelling and tenderness. On physical examination, no pathological findings were found except a very painful ulceronecrotic lesion with purulent discharge at the entrance of the vagina at six o’clock. In complete blood count, hemoglobin level was 12.6 g/dL, white blood cell was 4.210/mm3 and platelet count was 187.000/mm3. Erythrocyte sedimentation rate was 14 mm/hr and C-reactive protein was 26 mg/L. Serum biochemistry analysis and complete urinalysis were normal. After all cultures were taken, the patient was started on empirical intravenous piperacillin-tazobactam and fluconazole treatment. Oral paracetamol, ibuprofen and topical lidocaine were added to the treatment in addition to antimicrobial agents. Eye consultation was requested in terms of Behçet’s disease, uveitis was not seen. Pathergy test and HLA-B51 were negative. Vaginal and urine cultures were negative. Epstein-Barr virus, cytomegalovirus, herpes simplex virus (HSV) types I and II, Toxoplasma gondii, parvovirus B19, hepatitis B virus, hepatitis C virus, hepatitis A virus, human immunodeficiency virus and VDRL tests were negative. With the preliminary diagnosis of UVA, the patient was started on intravenous methylprednisolone (2 mg/kg/day). Topical steroids and anesthetics were applied to the lesions. After methylprednisolone treatment, the ulcer shrank rapidly and the pain was noticeably reduced. On the sixth day of her hospitalization, the dose of methylprednisolone was reduced to 1 mg/kg/day and she was discharged. No new lesions were observed in the follow-up and methylprednisolone was gradually discontinued within three weeks. No new lesion developed in the nine-month follow-up. The most common cause of genital ulcers is HSV and is associated with sexual activity. When vulvar ulcer is seen in children, sexual activity and sexual abuse history should be carefully questioned. If there is no history of sexual activity, UVA should be considered in the differential diagnosis after excluding all other possible causes.