Kinyó, Ágnes; Nagy, Nikoletta; Oláh, Judit; Kemény, Lajos; Bata-Csörgő, Zsuzsanna
Ulcus vulvae acutum Lipschütz or acute genital ulcer is a distinct clinical entity characterized by sudden painful genital ulceration occurring mostly in young and virgin girls with malaise, fever and other systemic symptoms. This distressing syndrome is rare and may be presented to dermatologists, gynecologists or pediatricians. Its diagnosis and therapy can be challenging. We present two young female patients with ulcus vulvae acutum. The cause of the disease could not be confirmed in our patients, but, interestingly, both patients had partial IgA deficiency. In the last 100 years, after its first description by Lipschütz, many case reports and series have aimed to identify a specific cause of the disease, without success. These studies mainly focused on infectious agents as causative factors, however, in most cases connection with infection could not be confirmed. Our opinion is that the decreased level of IgA could be a possible explanation for the cause of this syndrome. With our cases we would like to emphasize the possible role of local immunological mechanisms rather than several infectious agents in the development of this little-known disease.
Brinca, Ana; Canelas, Maria Miguel; Carvalho, Maria João; Vieira, Ricardo; Figueiredo, Américo
Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.
Sárdy, Miklós; Wollenberg, Andreas; Niedermeier, Andrea; Flaig, Michael J
Epstein-Barr virus (EBV) infection may rarely be associated with genital ulcers (ulcus vulvae acutum), a very painful manifestation. The aetiopathogenesis of the disease is not fully understood. We describe here a case of an adolescent virgin with multiple, deep genital ulcers associated with acute infectious mononucleosis. The diagnosis was supported by the clinical symptoms, atypical lymphocytosis, elevated circulating levels of liver enzymes, positive EBV serology, and the detection of EBV in a swab sample and a biopsy specimen by PCR. The virus could not be detected by immunohistochemistry or in situ hybridization. After a short course of methylprednisolone as a supportive treatment, the ulcers healed within one month. No relapse occurred during the 2-year follow-up. Available data relating to the aetiopathogenesis of this condition are reviewed, and we speculate that it may have been caused by percutaneous autoinoculation through cervicovaginal fluid.
Thiele, H; Kohler, U
The conservative treatment of venous crural ulcer is frustrating, and a recurrency rate of 25% is seen. Even after surgical treatment of the underlying venous disease, long-lasting septic complications and persistent wound infection occur. The combination of ESDP, paratibial fasciotomy and vacuum sealing therapy is a modern concept of varicose vein surgery. For the first time we are able to present a concept of surgery to cure venous crural ulcer definitely within an acceptably short period.
Gehring, W; Glutsch, J; Schönian, U; Gehse, M; Gloor, M
The germicidal influence of various antiseptics on the bacterial and fungal flora of leg ulcers was studied in vitro. Best effects were achieved by the triphenylmethane dyes brilliant green and methylrosaniline chloride. Chloramine and povidone iodine yielded average results, whereas the germicidal effects of potassium permanganate and eosin were not satisfactory. On the other hand, treatment with ozone resulted in sufficient inactivation of germs--with the only exceptions of Serratia and Klebsiella species. PMID:2284834
Alés-Fernández, M; Rodríguez-Pichardo, A; García-Bravo, B; Ferrándiz-Pulido, L; Camacho-Martínez, F M
A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.
Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora
Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers. PMID:24473429
Longeac, M; Lapeyre, M; Delbet Dupas, C; Barthélémy, I; Pham Dang, N
Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature. PMID:27105681
Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora
Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.
Puerto Alonso, J L; García-Martos, P; Girón González, J A
Arcanobacterium haemolyticum is a grampositive rod wich belonged, until a short time ago, to Corynebacterium genus, and recently classified in a new genus, with only one specie. Human is the main reservoir. It has been isolated from the skin and pharinx of healthy individuals, but also it is cause of infection, specially pharingitis, in children, and chronic cutaneous ulcus, in diabetic patients. Less frequently, it is cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. Diagnosis is difficult because its double quality: comensal and pathogen. There are not established guidelines for the treatment of these infections, although most of isolated strains are susceptibles to penicillin, erythromicin, clindamycin and tetracycline. High doses of penicillin, with or without gentamicin, it is recommended for the treatment of deep infections. PMID:12420635
Kamphausen, Thomas; Schadendorf, Dirk; von Wurmb-Schwark, Nicole; Bajanowski, Thomas; Poetsch, Micaela
The successful analysis of weak biological stains by means of highly sensitive short tandem repeat (STR) amplification has been increased significantly over the recent years. Nevertheless, the percentage of reliably analysable samples varies considerably between different crime scene investigations even if the nature of the stains appears to be the same. It has been proposed that the amount and quality of DNA left at a crime scene may be due to individual skin conditions (among other factors). Therefore, we investigated DNA from handprints from 30 patients acutely suffering from skin diseases like atopic dermatitis, psoriasis or skin ulcer before and after therapy by STR amplification using the new and highly sensitive Powerplex® ESX17 kit in comparison to 22 healthy controls. Handprints from atopic dermatitis patients showed a correct and reliable DNA profile in 90% and 40% of patients before and after therapy, respectively. Regarding psoriasis patients, we detected full DNA profiles in only 64% and 55% of handprints before and after therapy. In contrast, in ulcus patients and controls, full DNA profiles were obtained in much lower numbers. We conclude that active skin diseases like atopic dermatitis or psoriasis have a considerable impact on the amplificable DNA left by skin contact with surfaces. Since up to 7% of adults in European countries suffer from one of these diseases, this could explain at least partially the varying quality of DNA from weak stains.
Jesch, Ursula; Endler, P Christian; Wulkersdorfer, Beatrix; Spranger, Heinz
The ABO blood group system was discovered by Karl Landsteiner in 1901. Since then, scientists have speculated on an association between different pathologies and the ABO blood group system. The aim of this pilot study was to determine the significance between different blood types of the ABO blood group system and certain pathologies. We included 237 patients with known diagnosis, blood group, sex, and age in the study. As a statistical method, the Chi-square test was chosen. In some cases, a significant association between the blood groups and defined diseases could be determined. Carriers of blood group O suffered from ulcus ventriculi and gastritis (X(2)1 = 78.629, p < 0.001), colitis ulcerosa and duodenitis (X(2)1 = 5.846, p < 0.016), whereas male patients carrying blood group A tended to contract different types of tumours. In patients with intestinal tumours, females with blood group A were more likely to develop the pathology, whereas in males, the blood group O dominated. The development of cholelithiasis was found, above all, in patients with blood group O, which differed from other research where a correlation between this pathology and blood group A was found.
Petzoldt, D; Jappe, U; Hartmann, M; Hamouda, O
In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.
Rogers, R S
Recurrent aphthous stomatitis (RAS), commonly known as canker sores, has been reported as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. One of its variants is the most painful condition of the oral mucosa. Recurrent aphthous stomatitis has been the subject of active investigation along multiple lines of research, including epidemiology, immunology, clinical correlations, and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MiAU, MjAU, HU) and severity (simple versus complex). The natural history of individual lesions of RAS is important, because it is the bench mark against which treatment benefits are measured. The lesions of RAS are not caused by a single factor but occur in an environment that is permissive for development of lesions. These factors include trauma, smoking, stress, hormonal state, family history, food hypersensitivity and infectious or immunologic factors. The clinician should consider these elements of a multifactorial process leading to the development of lesions of RAS. To properly diagnose and treat a patient with lesions of RAS, the clinician must identify or exclude associated systemic disorders or "correctable causes." Behçet's disease and complex aphthosis variants, such as ulcus vulvae acutum, mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome, fever, aphthosis, pharyngitis, and adenitis (FAPA) syndrome, and cyclic neutropenia, should be considered. The aphthous-like oral ulcerations of patients with human immunodeficiency virus (HIV) disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause," which, with appropriate treatment, can result in a remission or
Böhmler, G; Gerwert, J; Scupin, E; Sinell, H J
In man suffering from diseases of the stomach and the duodenum (gastritis, ulcus, enteritis, neoplasms), Helicobacter pylori (H..pylori) is frequently detected in the mucous membrane of the stomach. Up to now the spread of this agent is not quite clear. Since the direct transmission in humans can be taken for granted, the following study was to find out whether and for how long the agent mentioned above is able to survive in selected food and whether an infection of the consumer by these contaminated food is possible. 376 samples of secretions from the udder of healthy cows and those with mastitis where tested for the presence of H. pylori along with 100 stomachs of chicken from different flocks. In no case H. pylori could be detected. H. pylori was inoculated in high concentrations into milk and some milk-products. From cooled milk samples the agent could still be reisolated after six days in a density up to 10(3) CFU/ml of milk. At room-temperature or 37 degrees C resp. the pathogen could be detected in milk for three to four days only. In yoghurt the agent kept viable for three hours only, whereas in kefir for 24 hours. Mean survival time of then hours was found in pH-neutral curd cheese. The incubation of H.pylori in sterile drip from chicken and in physiologic saline resulted in maximal survival time of at least 48 hours at room temperature. But in H.pylori-broth the number of microorganisms had dropped below the limit of detectability only after 72 hours. At refrigerator-temperature (7 degrees C) H. pylori could still be detected within these three media after 72 hours in high concentrations. In drip from chicken kept at-20 degrees C before thawing H. pylori showed a considerable survival time. After four weeks its number had only dropped by one to two log cycles, whereas in saline and in broth the agent could not be detected anymore after one week at the most. Experiments concerning tenacity showed: On culture-media with different pH-values the growth