Case and Research Letters
Comment on: Nonsexually Transmitted Acute Ulcer of the Vulva Associated With Influenza A Virus Infection
Úlcera vulvar aguda de transmisión no sexual asociada a infección por virus influenza A
I. López-Lerma
, M. Serra-Torres, V. García-Patos Briones
Autor para correspondencia
Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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López-Lerma, M. Serra-Torres, V. García-Patos Briones" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "López-Lerma" "email" => array:1 [ 0 => "Ilopez@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Serra-Torres" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "García-Patos Briones" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera vulvar aguda de transmisión no sexual asociada a infección por virus influenza A" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the letter published by Esteve-Martínez et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on nonsexually transmitted acute ulcer of the vulva, or ulcus vulvae acutum, associated with influenza A virus infection, and would like to congratulate the authors on their concise and thorough review of this condition.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We agree with their conclusion that it is important to be familiar with this type of vulvar ulcer and its association with influenza A virus infection,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> and would like to draw readers’ attention to fact that this ulcer can also occur in elderly patients, regardless of whether or not they report having had sexual relationships. One interesting case we saw recently was that of a 20-year-old woman with necrotizing genital ulcers that had required debridement in the gynecology department at our hospital.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient, with no relevant past history, reported that she had experienced fever and generalized joint pain 11 days before being seen in the dermatology department. She had been prescribed treatment with antipyretic medication and a single dose of oral levofloxacin by her primary care physician. Four hours after ingestion, the patient noted vulvar discomfort and an inflamed area. In the next 24<span class="elsevierStyleHsp" style=""></span>hours, she also developed pharyngeal discomfort and a worsening general state of health, leading her to visit the emergency department, where a polymerase chain reaction (PCR) assay confirmed influenza A subtype H1N1 infection. The patient was admitted and treated with oseltamivir. During her stay in hospital, several deep, bilateral genital ulcers with necrotic-looking borders were noticed. Several swab specimens were obtained for standard culture, <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> culture, and PCR testing for <span class="elsevierStyleItalic">Chlamydia trachomatis</span>, herpes simplex virus types 1 and 2, and samples were taken for serology. Empirical treatment was initiated with ceftriaxone (single dose), oral acyclovir, and amoxicillin-clavulanic acid. The ulcers, however, continued to deteriorate and it was decided to debride the area. In view of the worsening condition of the patient, and the negative results for the viral cultures, the PCR tests, and serology for syphilis and human immunodeficiency virus (HIV), her physicians decided to request dermatologic evaluation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">At the time of this evaluation, there was marked vulvar edema and the posterior region of the right labia minora had been resected, leaving an ulcerated area with a clean base. On the left side of the vulva, there was a 1.5-cm exudative ulcer with a fibrinous base. The lesions were painful and accompanied by bilateral enlarged inguinal lymph nodes of less than 1<span class="elsevierStyleHsp" style=""></span>cm. Topical treatment with absorbent dressings and fusidic acid was prescribed. The ulcers improved and began to heal within a few days; 3 weeks later, they had healed completely. Serology was negative for HIV I and II, syphilis, and cytomegalovirus. Epstein-Barr virus serology was negative for immunoglobulin (Ig) M antibodies and positive for IgG antibodies. No antinuclear antibodies were detected.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The differential diagnosis we considered included other causes of acute genital ulcer such as sexually transmitted diseases, lesions caused by trauma, complex aphthosis, and ulcerative lesions associated with autoimmune diseases or inflammatory bowel disease.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> In our case, the final diagnosis was ulcus vulvae acutum in association with H1N1 influenza A virus infection, although we cannot rule out the possibility that the drugs taken by the patient during her illness contributed to the aggressive course of the disease and the necrotic appearance of the lesions. There have been several reports of acute genital ulcers associated with influenza virus infection in the last 3 years, but it is not known whether this association is due to new mutations of the virus or to the concomitant ingestion of drugs. Prospective studies will help to determine whether the prevalence and course of ulcus vulvae acutum in patients with influenza differ depending on whether they receive oseltamivir or purely symptomatic treatment. Familiarity with this disease in emergency and dermatology departments will improve the management of these patients and prevent unnecessary interventions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Lerma I, et al. Ùlcera vulvar aguda de transmisión no sexual asociada a infección por virus influenza A. Actas Dermosifiliogr.2011;102:832-833.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Úlcera vulvar aguda de trasmisión no sexual asociada a infección por virus influenza A" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Esteve-Martínez" 1 => "J. López-Davia" 2 => "A. García-Rabasco" 3 => "I. Febrer-Bosch" 4 => "V. 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| 2021 Agosto | 37 | 47 | 84 |
| 2021 Julio | 43 | 48 | 91 |
| 2021 Junio | 41 | 41 | 82 |
| 2021 Mayo | 37 | 67 | 104 |
| 2021 Abril | 116 | 151 | 267 |
| 2021 Marzo | 90 | 44 | 134 |
| 2021 Febrero | 75 | 49 | 124 |
| 2021 Enero | 51 | 41 | 92 |
| 2020 Diciembre | 49 | 36 | 85 |
| 2020 Noviembre | 34 | 45 | 79 |
| 2020 Octubre | 46 | 26 | 72 |
| 2020 Septiembre | 53 | 37 | 90 |
| 2020 Agosto | 39 | 44 | 83 |
| 2020 Julio | 53 | 30 | 83 |
| 2020 Junio | 36 | 56 | 92 |
| 2020 Mayo | 33 | 47 | 80 |
| 2020 Abril | 47 | 50 | 97 |
| 2020 Marzo | 39 | 96 | 135 |
| 2020 Febrero | 11 | 179 | 190 |
| 2020 Enero | 4 | 110 | 114 |
| 2019 Diciembre | 8 | 52 | 60 |
| 2019 Noviembre | 4 | 20 | 24 |
| 2019 Octubre | 0 | 21 | 21 |
| 2019 Septiembre | 4 | 22 | 26 |
| 2019 Agosto | 4 | 13 | 17 |
| 2019 Julio | 4 | 18 | 22 |
| 2019 Junio | 4 | 16 | 20 |
| 2019 Mayo | 7 | 19 | 26 |
| 2019 Abril | 3 | 35 | 38 |
| 2019 Marzo | 4 | 34 | 38 |
| 2019 Febrero | 0 | 32 | 32 |
| 2019 Enero | 2 | 10 | 12 |
| 2018 Diciembre | 5 | 7 | 12 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 25 | 25 |
| 2018 Marzo | 2 | 19 | 21 |
| 2018 Febrero | 152 | 32 | 184 |
| 2018 Enero | 156 | 39 | 195 |
| 2017 Diciembre | 105 | 20 | 125 |
| 2017 Noviembre | 110 | 27 | 137 |
| 2017 Octubre | 86 | 19 | 105 |
| 2017 Septiembre | 76 | 17 | 93 |
| 2017 Agosto | 118 | 35 | 153 |
| 2017 Julio | 96 | 23 | 119 |
| 2017 Junio | 106 | 48 | 154 |
| 2017 Mayo | 84 | 25 | 109 |
| 2017 Abril | 80 | 30 | 110 |
| 2017 Marzo | 62 | 57 | 119 |
| 2017 Febrero | 77 | 28 | 105 |
| 2017 Enero | 69 | 24 | 93 |
| 2016 Diciembre | 121 | 12 | 133 |
| 2016 Noviembre | 107 | 16 | 123 |
| 2016 Octubre | 73 | 22 | 95 |
| 2016 Septiembre | 93 | 21 | 114 |
| 2016 Agosto | 91 | 19 | 110 |
| 2016 Julio | 62 | 11 | 73 |
| 2016 Junio | 17 | 11 | 28 |
| 2016 Mayo | 10 | 16 | 26 |
| 2016 Abril | 7 | 27 | 34 |
| 2016 Marzo | 8 | 14 | 22 |
| 2016 Febrero | 8 | 13 | 21 |
| 2016 Enero | 7 | 11 | 18 |
| 2015 Diciembre | 10 | 5 | 15 |
| 2015 Noviembre | 15 | 6 | 21 |
| 2015 Octubre | 12 | 6 | 18 |
| 2015 Septiembre | 13 | 2 | 15 |
| 2015 Agosto | 14 | 8 | 22 |
| 2015 Julio | 47 | 10 | 57 |
| 2015 Junio | 43 | 8 | 51 |
| 2015 Mayo | 83 | 25 | 108 |
| 2015 Abril | 77 | 15 | 92 |
| 2015 Marzo | 50 | 14 | 64 |
| 2015 Febrero | 29 | 9 | 38 |
| 2015 Enero | 36 | 17 | 53 |
| 2014 Diciembre | 49 | 24 | 73 |
| 2014 Noviembre | 34 | 13 | 47 |
| 2014 Octubre | 48 | 14 | 62 |
| 2014 Septiembre | 36 | 10 | 46 |
| 2014 Agosto | 52 | 20 | 72 |
| 2014 Julio | 50 | 19 | 69 |
| 2014 Junio | 54 | 17 | 71 |
| 2014 Mayo | 83 | 17 | 100 |
| 2014 Abril | 54 | 13 | 67 |
| 2014 Marzo | 86 | 18 | 104 |
| 2014 Febrero | 44 | 14 | 58 |
| 2014 Enero | 64 | 14 | 78 |
| 2013 Diciembre | 52 | 12 | 64 |
| 2013 Noviembre | 14 | 10 | 24 |
| 2013 Octubre | 12 | 14 | 26 |
| 2013 Septiembre | 10 | 7 | 17 |
| 2013 Agosto | 16 | 9 | 25 |
| 2013 Julio | 13 | 19 | 32 |
| 2013 Junio | 10 | 16 | 26 |
| 2013 Mayo | 20 | 3 | 23 |
| 2013 Abril | 14 | 18 | 32 |
| 2013 Marzo | 23 | 11 | 34 |
| 2013 Febrero | 58 | 12 | 70 |
| 2013 Enero | 48 | 11 | 59 |
| 2012 Diciembre | 29 | 4 | 33 |
| 2012 Julio | 1 | 0 | 1 |
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