A ten-year-old girl presented to the emergency department with a two-day history of high fever, headache and odynophagia, treated for genital lesions very painful in the last 24 hours.
Absence of menarche, sexual contact, or previous genital trauma
Genital examination revealed erythema and edema of both labia majora, with minor symmetric ulcers rectified fibrin seals and painful satellite lesions, the largest longitudinal diameter in both labia minora and several periloid.
Rest of the examination showed no relevant findings.
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Complementary tests showed leukocytosis of 22.38/μl and C-reactive protein of 138.9 mg/l, with normal renal, hepatic and urinary sediment function.
Erythema multiforme, lymphogranuloma venereum, chancroid
The patient was admitted to hospital with analgesia, sedation and saline stimulation.
The torpid evolution is added to the treatment broad-spectrum antibiotics, virida IV and oral corticotherapy, waiting for the results of the cultures.
Urocultive, hemocultive and culture of vaginal and cervical exudate (for C. trachomatis), as well as smears of genital ulcers were negative.
Serology for EBV, CMV, Brucella, Rose of Bengal, human immunodeficiency virus and you were negative.
DNA of herpes simplex virus types I and II was determined by polymerase chain reaction of the genital ulcer sample, which was finally negative.
The diagnosis by exclusion of Lipschütz ulcer in its most mucosal form is established. It is decided to discharge the patient seven days after admission, persisting multiple ulcerations with loss of genital tissue, without inflammatory appearance.
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The condition was almost completely resolved seven weeks after diagnosis.
