Adolescent female with vaginal pain

An 11-year-old premenarchal female presented to the emergency department with a painful vaginal lesion associated with dysuria. For the last 3 days she had fever and symptoms of an upper respiratory tract infection. She denied any history of sexual activity or trauma. The patient's external genital examination is shown (Figure 1). The patient underwent laboratory work that revealed a normal complete blood count and comprehensive metabolic panel. She was found to be positive for influenza A. Urinalysis revealed 19 white blood cell count with more than two leukocyte esterase and negative nitrites. The patient was admitted to the hospital for monitoring and pain control. Urine culture was negative. The labia were swabbed for gonorrhea and chlamydia, which were negative. Epstein–Barr virus serology was negative. Lipschütz ulcer is an uncommon, self-limited, non-sexually transmitted condition characterized by the rapid onset of painful, necrotic ulcerations of the vulva or lower vagina. The ulcers are typically deep, with red borders and necrosis, sometimes covered by gray exudate or gray–black eschar, primarily affecting the medial face of the labia, including secondary erythema and edema. They usually occur in non-sexually active adolescent girls or young women and may be preceded by influenza-like or mononucleosis-like symptoms.1 The differential diagnosis includes infections, Behçet's syndrome, and malignant tumors. The course is self-limited, and spontaneous healing usually occurs in 2–6 weeks with no scarring and no recurrence.2 Treatment includes supportive care with sitz baths, topical lidocaine, and oral pain medications, as needed.3