![]() Additionally, the patient reported a history of recurrent oral ulcerations but no previous history of genital ulcerations. Her medical history was significant for several congenital conditions requiring corrective surgeries including soft palate cleft, club foot, syndactyly of her left foot, and congenital hearing impairment in the right ear. She had no respiratory symptoms and no known COVID-19 exposure. Gynecology was consulted and recommended assessment for likely Lipschütz ulcers.Īt the gynecology clinic, it was found that the patient's lesions were exquisitely painful, resulting in difficulty with urination, defecation, and walking. ![]() By this point, the lesions were covered in exudate with a necrotic, ring-like border. Despite antibiotic therapy, her symptoms continued to worsen, prompting her to return to the clinic 2 days later. She presented to urgent care with a fever of 105° Fahrenheit and was diagnosed with a Bartholin gland abscess and prescribed amoxicillin-clavulanate. Over the next 2 days, the right-sided lesions in her vaginal area coalesced and became more painful. Within 24 hours of receiving the vaccine, she developed fever, fatigue, myalgias, and lesions in her vaginal area. Six days prior, she had received her second dose of the Pfizer BioNTech (BNT162b2) COVID-19 vaccine. The objectives of this case report are to highlight a novel etiology of vulvar aphthous ulcers and to discuss potential mechanisms of disease.Ī 16-year-old non-sexually active female presented to the pediatric gynecology clinic with vaginal pain. Furthermore, this is the first case report to describe vulvar aphthous ulcer after vaccination, among both mRNA and conventional vaccines. In this report, we present the case of a patient presenting with vulvar aphthous ulcer following Pfizer BioNTech (BNT162b2) COVID-19 vaccination. 4 These manifestations were hypothesized to be a hypersensitivity reaction either to the spike protein or to some other component of the vaccine. Histologic examination revealed neutrophils, dilated vessels, and lymphocytic infiltration. In one study, delayed injection-site reaction was present in 2.1% of subjects, with 4.9% demonstrating disseminated lesions. Skin manifestations have been observed following the Moderna (mRNA-1273) and Pfizer-BioNTech (BNT162b2) vaccines. 3 Headache, fatigue, chills, diarrhea, fever, and myalgias were common systemic adverse effects, whereas local adverse effects included pain, swelling, tenderness, and itching. In a prospective observational study conducted using data from the COVID Symptom study application, 22% of 28,207 patients reported systemic adverse effects after receiving the second dose of the Pfizer BioNTech (BNT162b2) vaccine. ![]() Side effects are common and have been widely reported. Over 334,000,000 doses of the Moderna, Pfizer, and Johnson & Johnson vaccine have been administered since December of 2020. 2 Vulvar aphthous ulcers have also presented as a cutaneous manifestation of noninfectious conditions such as Behcet's disease and Crohn's disease. 1 In a case series of 13 pubertal females, 31% of vulvar aphthous ulcers were associated with EBV. ![]() Numerous case reports have described aphthous ulcers as a dysregulated immune response associated with a variety of infections including cytomegalovirus (CMV), influenza, mumps virus, salmonella, mycoplasma, and, most notably, Epstein-Barr virus (EBV). The underlying pathogenesis of vulvar aphthous ulcers is unclear. 1 A violaceous border, necrotic base, and fibrinous exudate are other key features of the lesions. Lesions are typically large, red, and erosive, ranging from 0.3 to 5 cm in one study. Patients typically present with sudden onset of one or multiple genital ulcerative lesions coupled with an influenza-like prodrome. Although the majority of genital ulcers are sexually transmitted, aphthous ulcers are the most common cause of non-transmissible vulvar ulcers. Aphthous ulcers, otherwise known as Lipschütz ulcers, acute genital ulcers, and acquired genital ulceration, represent a painful, distressing condition of the vulva and lower vagina that overwhelmingly affects non-sexually active adolescent females.
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