A Úlcera de Lipschutz na infância e adolescência: revisão de literatura
DOI:
https://doi.org/10.5327/JBG-2965-3711-145%20Palabras clave:
úlcera de Lipschutz, lesão vulvar, úlceras vulvares na pediatriaResumen
A úlcera de Lipschutz caracteriza-se por lesão em região vulvar, que podem ser múltiplas ou únicas, são frequentemente dolorosas e sem correlação com atividade ou transmissão sexual. É um quadro autolimitado e acomete a população pediátrica, com maior prevalência dos 11 aos 16 anos. A presente pesquisa buscou esclarecer sobre o diagnóstico correto para informar e auxiliar os profissionais de saúde no tratamento clínico da úlcera de Lipschutz. Realizado uma revisão de literatura, utilizando os artigos da plataforma PubMed, publicados no período de 2014 a 2024, obtidos por pesquisa com a palavra-chave “lipschutz ulcer”, resultando na seleção de 65 artigos. A etiologia da doença não é clara, embora seja relacionada a contato prévio com vírus como epstein barr, citomegalovírus, coronavirus, influenza e Paramyxovirus. A semelhança clínica e da apresentação das lesões, com infecções sexualmente transmissíveis, permite ao equívoco diagnóstico, sendo necessário realização de exames complementares para auxiliar na definição do caso. O tratamento dos casos são sintomáticos com analgésicos e limpeza local, com poucos casos relatados com necessidade de internação e uso de antibioticoterapia.
Descargas
Citas
1. Merlino L, Volpicelli AI, Dominoni M, Pasquali MF, D’Ovidio G, Gardella B, et al. Lipschutz ulcer and SARS-CoV-2: what we currently know? Diseases. 2023;11(3):121. https://doi.org/10.3390/diseases11030121
2. Sadoghi B, Stary G, Wolf P, Komericki P. Ulcus vulvae acutum Lipschutz: a systematic literature review and a diagnostic and therapeutic algorithm. J Eur Acad Dermatol Venereol. 2020;34(7):1432-9. https://doi.org/10.1111/jdv.16161
3. Barnwal S, Priya D, Kala PS, Sangal B, Pant A. Dysplastic changes secondary to cytomegalovirus-induced Lipschutz ulcer: unraveling complexity. Indian J Sex Transm Dis AIDS. 2024;45(1):69-71. https://doi.org/10.4103/ijstd.ijstd_6_24
4. Lerner HM. Lipschutz syndrome: not all genital ulcers are herpes. Clin Pediatr (Phila). 2024;63(5):613-6. https://doi.org/10.1177/00099228231186867
5. Gibert A, Bell Y. Lipschutz ulcer: presentation of 2 cases. Semergen. 2016;42(8):590-3. https://doi.org/10.1016/j.semerg.2016.01.005
6. Moise A, Nervo P, Doyen J, Kridelka F, Maquet J, Vandenbossche G. Ulcer of Lipschutz, a rare and unknown cause of genital ulceration. Facts Views Vis Obgyn. 2018;10(1):55-7. PMID: 30510669.
7. Elkhachine Y, Sakkah A, Jakar A, Elhaouri M, Elbenaye J. Lipschutz acute genital ulcer. Presse Med. 2019;48(9):1003-4. https://doi.org/10.1016/j.lpm.2019.08.012
8. Leal AAS, Piccinato CA, Beck APA, Gomes MTV, Podgaec S. Acute genital ulcers: keep Lipschutz ulcer in mind. Arch Gynecol Obstet. 2018;298(5):927-31. https://doi.org/10.1007/s00404-018-4866-6
9. Delgado-García S, Palacios-Marqués A, Martínez-Escoriza JC, Martín-Bayón TA. Acute genital ulcers. BMJ Case Rep. 2014;2014:bcr2013202504. https://doi.org/10.1136/bcr-2013-202504
10. Mourinha V, Costa S, Urzal C, Guerreiro F. Lipschutz ulcers: uncommon diagnosis of vulvar ulcerations. BMJ Case Rep. 2016;2016:bcr2015214338. https://doi.org/10.1136/bcr-2015-214338
11. Ewig E, Ben Othman N, Viard D, Gauci PA, Rocher F, Drici MD. Lipschutz ulcer following first dose of COVID-19 tozinameran vaccine: report of a case and review of a World Health Organization pharmacovigilance database. Int J Gynaecol Obstet. 2025;168(3):958-64. https://doi.org/10.1002/ijgo.15941
12. Scott SM, Alaniz V, Appiah L, Buyers E, Holton C, Huguelet P. Vulvar aphthous ulcers in an adolescent after coronavirus disease 2019 (COVID-19) vaccination. Obstet Gynecol. 2022;140(3):514-7. https://doi.org/10.1097/AOG.0000000000004885
13. Charamanta M, Soldatou A, Michala L. Vulvar ulcers in children: dramatic but self-limited. Pediatr Emerg Care. 2021;37(2):70-2. https://doi.org/10.1097/PEC.0000000000002004
14. Meyer Sauteur PM, Stähli N, Theiler M, Hürlimann R, Berger C. Mycoplasma pneumoniae-induced non-sexually acquired genital ulceration (Lipschutz ulcers). Arch Dis Child. 2020;105(5):517-8. https://doi.org/10.1136/archdischild-2019-317676
15. Huppert JS. Lipschutz ulcers: evaluation and management of acute genital ulcers in women. Dermatol Ther. 2010;23(5):533-40. https://doi.org/10.1111/j.1529-8019.2010.01356.x
16. Brambilla I, Bolcato V, Volonté M, Querzani A, Guarracino C, Tondina E, et al. Lipschutz ulcers due to SARS-CoV-2 infection: a neglected diagnosis in emergency room. Int J Womens Dermatol. 2024;10(1):e122. https://doi.org/10.1097/JW9.0000000000000122
17. Schmitt TM, Devries J, Ohns MJ. Lipschutz ulcers in an adolescent after SARS-CoV-2 infection. J Pediatr Health Care. 2023;37(1):63-6. https://doi.org/10.1016/j.pedhc.2022.09.005
18. Wojcicki AV, O'Brien KLOF. Vulvar aphthous ulcer in an adolescent after Pfizer-BioNTech (BNT162b2) COVID-19 vaccination. J Pediatr Adolesc Gynecol. 2022;35(2):167-70. https://doi.org/10.1016/j.jpag.2021.10.005
19. Vismara SA, Lava SAG, Kottanattu L, Simonetti GD, Zgraggen L, Clericetti CM, et al. Lipschütz’s acute vulvar ulcer: a systematic review. Eur J Pediatr. 2020;179(10):1559-67. https://doi.org/10.1007/s00431-020-03647-y
20. Hsu T, Sink JR, Alaniz VI, Zheng L, Mancini AJ. Acute genital ulceration after severe acute respiratory syndrome coronavirus 2 vaccination and infection. J Pediatr. 2022;246:271-3. https://doi.org/10.1016/j.jpeds.2022.04.005
21. Pereira DAG, Teixeira EPP, Lopes ACM, Sarmento RJP, Lopes APC. Lipschutz ulcer: an unusual diagnosis that should not be neglected. Rev Bras Ginecol Obstet. 2021;43(5):414-6. https://doi.org/10.1055/s-0041-1729147
22. González García J, Moreno Pavón B, Míguez Martín L, Fernández Martínez B, Molinos Norniella C, Álvaro Caro F. Lipschutz ulcer: a cause of misdiagnosis when suspecting child abuse. Am J Emerg Med. 2016;34(7):1326.e1-2. https://doi.org/10.1016/j.ajem.2015.12.027
23. Brambilla I, Moiraghi A, Guarracino C, Pistone C, Tondina E, Riccipetitoni G, et al. Recurrent reactive non-sexually related acute genital ulcers: a risk factor for Behcet's disease? Acta Biomed. 2022;93(S3):e2022196. https://doi.org/10.23750/abm.v93iS3.13077
24. Miyazawa T, Hayashibe R, Nozawa T, Nishimura K, Ito S. Lipschütz ulcer induced by acute Epstein-Barr virus infection in a young girl. Pediatr Int. 2022;64(1):e15022. https://doi.org/10.1111/ped.15022
25. Bounniyt H, Mael-Ainin M, Bouhallab J, Hassam B. Lipschutz ulcer: a rare case of genital ulcers. Presse Med. 2015;44(1):117-8. https://doi.org/10.1016/j.lpm.2014.04.018
26. Horie C, Kano Y, Mitomo T, Shiohara T. Possible involvement of Mycoplasma fermentans in the development of nonsexually acquired genital ulceration (Lipschutz ulcers) in 3 young female patients. JAMA Dermatol. 2015;151(12):1388-9. https://doi.org/10.1001/jamadermatol.2015.2061
27. Waterman CL, Aronson IK. Recurrence of non-sexually acquired acute genital ulceration following COVID-19 vaccination. Dermatol Online J. 2023;29(6). https://doi.org/10.5070/D329663000
28. Sindhuja T, Khaitan BK, Agarwal S, Agarwala S, Bhari N. Lipschutz ulcers in a 4-month-old girl. Pediatr Dermatol. 2022;39(5):827-9. https://doi.org/10.1111/pde.15034
29. Kumar R, Burns EA. Age-related decline in immunity: implications for vaccine responsiveness. Expert Rev Vaccines. 2008;7(4):467-79. https://doi.org/10.1586/14760584.7.4.467
30. Setiawan J, Kammann C, Miles C, Hazelton B, Martin A. Lipschutz's acute genital ulcers in a toddler: an unusual presentation of Epstein-Barr virus infection. J Paediatr Child Health. 2024;60(6):246-7. https://doi.org/10.1111/jpc.16562
31. Barrett MM, Sangüeza M, Werner B, Kutzner H, Carlson JA. Lymphocytic arteritis in Epstein-Barr virus vulvar ulceration (Lipschutz disease): a report of 7 cases. Am J Dermatopathol. 2015;37(9):691-8. https://doi.org/10.1097/DAD.0000000000000316
32. Martín JM, Godoy R, Calduch L, Villalón G, Jordá E. Lipschutz acute vulval ulcers associated with primary cytomegalovirus infection. Pediatr Dermatol. 2008;25(1):113-5. https://doi.org/10.1111/j.1525-1470.2007.00597.x
33. van Bommel MHD, Rijnders RJP. Acute genital ulcers in a young woman. Ned Tijdschr Geneeskd. 2019;163:D3814. PMID: 31769629.
34. Hsu T, Sink JR, Alaniz VI, Zheng L, Mancini AJ. Acute genital ulceration after severe acute respiratory syndrome coronavirus 2 vaccination and infection. J Pediatr. 2022;246:271-3. https://doi.org/10.1016/j.jpeds.2022.04.005
35. Jeyanathan M, Afkhami S, Smaill F, Miller MS, Lichty BD, Xing Z. Immunological considerations for COVID-19 vaccine strategies. Nat Rev Immunol. 2020;20(10):615-32. https://doi.org/10.1038/s41577-020-00434-6
36. Crofts VL, Clothier HJ, Mallard J, Buttery JP, Grover SR. Vulval (Lipschutz) ulcers in young females associated with SARS-CoV-2 infection and COVID-19 vaccination: case series. Arch Dis Child. 2023;108(4):326-7. https://doi.org/10.1136/archdischild-2022-325149
37. Popatia S, Chiu YE. Vulvar aphthous ulcer after COVID-19 vaccination. Pediatr Dermatol. 2022;39(1):153-4. https://doi.org/10.1111/pde.14881
38. Khayat-Khoei M, Bhattacharyya S, Katz J, Harrison D, Tauhid S, Bruso P, et al. COVID-19 mRNA vaccination leading to CNS inflammation: a case series. J Neurol. 2021;269(3):1093-106. https://doi.org/10.1007/s00415-021-10780-7
39. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;220:1-13. https://doi.org/10.1016/j.trsl.2020.04.007
40. Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep. 2021;14(5):e242653. https://doi.org/10.1136/bcr-2021-242653
41. Vismara SA, Ridolfi A, Faré PB, Bianchetti MG, Lava SAG, Renzi S, et al. COVID-19, coronavirus vaccines, and possible association with lipschütz vulvar ulcer: a systematic review. Clin Rev Allergy Immunol. 2023;65(2):166-71. https://doi.org/10.1007/s12016-023-08961-5
42. Wetter DA, Bruce AJ, MacLaughlin KL, Rogers 3rd RS. Ulcus vulvae acutum in a 13-year-old girl after influenza A infection. Skinmed. 2008;7(2):95-8. https://doi.org/10.1111/j.1751-7125.2008.07273.x
43. Haidari G, MacMahon E, Tong CYW, White JA. Genital ulcers: it is not always simplex…. Int J STD AIDS. 2015;26(1):72-3. https://doi.org/10.1177/0956462414541241
44. Chanal J, Carlotti A, Laude H, Wallet-Faber N, Avril MF, Dupin N. Lipschutz genital ulceration associated with mumps. Dermatology. 2010;221(4):292-5. https://doi.org/10.1159/000319857
45. Mikkelson MD, Fox MK, Cooper OR, Ragland CL. Nonsexual acute genital ulcerations as a rare presentation of disseminated Lyme disease in a pediatric patient. J Pediatr Adolesc Gynecol. 2024;37(3):375-7. https://doi.org/10.1016/j.jpag.2023.12.005
46. Lerner HM. Lipschütz syndrome: not all genital ulcers are herpes. Clin Pediatr (Phila). 2024;63(5):613-6. https://doi.org/10.1177/00099228231186867
47. Horie C, Kano Y, Mitomo T, Shiohara T. Possible involvement of Mycoplasma fermentans in the development of nonsexually acquired genital ulceration (Lipschütz ulcers) in 3 young female patients. JAMA Dermatol. 2015;151(12):1388-9. https://doi.org/10.1001/jamadermatol.2015.2061
48. Limão S, Ventura A, Queirós G, Cunha F. Lipschutz ulcer and group A streptococcal tonsillitis. BMJ Case Rep. 2018;2018:bcr2017223579. https://doi.org/10.1136/bcr-2017-223579
49. Nielsen SK, Barbosa MEMP. Lipschutz ulcus as a differential diagnosis of vulvar ulcus. Ugeskr Laeger. 2018;180(14):V11170833. PMID: 29622067.
50. Morón-Ocaña JM, Lorente-Lavirgen AI, Coronel-Pérez IM, Martínez-Barranca ML. Lipschutz's vulvar ulcer in an adolescent after Pfizer COVID-19 vaccine. An Bras Dermatol. 2024;99(1):125-6. https://doi.org/10.1016/j.abd.2023.03.003
51. Mendes JF, Alves S, Pinheiro MI, Reis JS. Lipschutz ulcer as a possible SARS-COV-2 manifestation. An Pediatr (Engl Ed). 2024;100(2):151-2. https://doi.org/10.1016/j.anpede.2023.11.005
52. Arellano J, Fuentes E, Moreno P, Corredoira Y. Ulcer of Lipschutz, a diagnosis to consider in the pediatric population. Arch Argent Pediatr. 2019;117(3):e305-e308. https://doi.org/10.5546/aap.2019.e305
53. Schafer F, Miranda R. Acute genital ulcers in a young girl: a clinical challenge: Lipschütz ulcer. An Bras Dermatol. 2022;97(5):682-3. https://doi.org/10.1016/j.abd.2020.12.018
