Vulvar ulcers after COVID‐19 vaccination

Multiple cases of COVID-19 vaccine-triggered vulvar ulcers have been reported in medical literature. 

A 12-year-old healthy girl without prior sexual activity nor history of oral or genital ulcers presented with a 1-day history of vulvar ulcers with associated swelling and pain three days after receiving the second dose of the Pfizer COVID-19 vaccine. Her condition resolved within 10 days after treatment. 

A 12-year-old otherwise-healthy female patient presented with painful vulvar ulcerations that had been present for approximately 5 days, starting from 2 days after her 2nd Pfizer vaccine. Ulcers healed over the course of 2 weeks after treatment. 

A virginal 14-year-old girl reported vulvar pain and visible lesion. Exam findings were consistent with vulvar aphthous ulcers. Two days prior to the onset of her symptoms she received her second Pfizer-BioNTech COVID-19 vaccine. The evening of vaccine administration, she experienced several hours of fatigue, muscle aching and insomnia. By the next morning, her symptoms had resolved. Her medical history was significant for heavy menstrual bleeding and Type I von Willebrand disease, for which she used extended cycle combination oral contraceptives. Testing for common viral associations of vulvar ulcers was negative. Her condition resolved 10 days later. 

A 14-year-old experienced vulvar ulceration 3 days after her second dose of the Pfizer-BioNTech SARS-CoV-2 vaccine. After two courses of treatment, four weeks later, the ulcers were nearly healed.

A 16-year-old non-sexually active female presented to the pediatric gynecology clinic with vaginal pain six days after receiving her second dose of the Pfizer BioNTech (BNT162b2) COVID-19 vaccine. Within 24 hours of receiving the vaccine, she developed fever, fatigue, myalgias, and lesions in her vaginal area. Antibiotics did not help. After proper diagnosis and treatment with topical clobetasol she3 reported improvement in her symptoms, although 2 weeks later she was experiencing sensitivity and pain with urination.

A 24-year-old woman presented to the emergency department with 4 very painful ulcers on labia majora, 3 days after receiving the AstraZeneca vaccine. She had a history of ulcers and tested negative to herpes simplex virus types 1 and 2, Treponema pallidum, Mycoplasma genitalium, Trichomonas vaginalis, and Neisseria gonorrhoeae. Serology for syphilis, HIV, and hepatitis A, B and C viruses and the autoimmune study were negative. The patient was not a carrier of the HLA B*51 or HLA B*57 allele. Treatment with a tapering dose of prednisone 30 mg and analgesics led to a rapid improvement in pain. At 3 weeks, the patient was asymptomatic, and the ulcers had disappeared.

A 29-year-old female with a history of asthma complaint of recurrent genital ulcers that began 24 hours after her first Moderna-SARS-CoV-2 vaccine and worsened two days after her 2nd dose. The lesions resolved after treatment. 

a 33-year-old female developed a Lipschütz ulcer after being vaccinated with the second dose of the AstraZeneca COVID-19 vaccine. She reported having had only one sexual partner in her lifetime.

Another case reported in a Brazilian adolescent fafter Pfizer vaccine. 

REFERENCES

Popatia S, Chiu YE. Vulvar aphthous ulcer after COVID‐19 vaccination. Pediatric Dermatology. 2022 Jan;39(1):153-4.

González-Romero N, Morillo Montañes V, Vicente Sánchez I, García García M. [[Translated article]]Lipschütz Ulcers after the AstraZeneca COVID-19 Vaccine. Actas Dermosifiliogr. 2022 Oct 10:S0001-7310(22)00873-0. English, Spanish. doi: 10.1016/j.ad.2022.10.019. Epub ahead of print. PMID: 36228713; PMCID: PMC9549747.

Huppert J. Adolescents with Vulvar Ulcers: COVID-19 disease, COVID-19 Vaccines, and the Value of Case Reports. Journal of Pediatric and Adolescent Gynecology. 2022 Apr 1;35(2):109-11.

Drucker A, Corrao K, Gandy M. Vulvar aphthous ulcer following Pfizer-BioNTech COVID-19 vaccine–a case report. Journal of Pediatric and Adolescent Gynecology. 2022 Apr 1;35(2):165-6.

Wojcicki AV, O'Brien KL. Vulvar aphthous ulcer in an adolescent after Pfizer-BioNTech (BNT162b2) COVID-19 vaccination. Journal of Pediatric and Adolescent Gynecology. 2022 Apr 1;35(2):167-70.

Sangster-Carrasco L, Paz-Temoche R, Coronado-Arroyo J, Concepción-Zavaleta M, Roseboom P, Concepción-Urteaga L, Zavaleta-Gutiérrez F. Lipschütz acute vulvar ulcer related to COVID-19 vaccination: First case report in South America. Medwave. 2023 Mar 10;23(2). English. doi: 10.5867/medwave.2023.02.2674. PMID: 36947719.

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