COVID-19 News: Yet Another Case Report Showing That SARS-CoV-2 Infections Can Cause Genital Ulcers In Women!

COVID-19 News: The COVID-19 pandemic has brought forth a myriad of clinical presentations, challenging our understanding of the virus's impact on the human body. Among the intriguing revelations is the association between SARS-CoV-2 infections and the development of Acute Genital Ulcers (AGU) in women. This COVID-19 News report explores a compelling case study from the First Affiliated Hospital of Chongqing Medical University in Chongqing, China, shedding light on the intricate details of this rare phenomenon and its potential implications for medical practitioners worldwide.


SARS-CoV-2 Infections Can Cause Genital Ulcers In Women
 
Already Thailand Medical News had in our previous coverages had presented numerous cases studies and case reports showing that SARS-CoV-2 infections can cause genital ulcers and even necrotizing genital ulcers in women.
https://www.thailandmedical.news/news/breaking-covid-19-news-medical-researchers-from-portugal-warn-that-sars-cov-2-infections-can-lead-to-vulvar-ulceration-in-girls-and-women
 
https://www.thailandmedical.news/news/breaking-news-italian-study-finds-that-covid-19-infections-and-vaccines-can-cause-onset-of-necrotic-ulcerations-of-the-vulva-or-lower-vagina
 
Off late more such incidences are being reported in various geolocations around the world!
 
Understanding Acute Genital Ulcers
Acute Genital Ulcers, colloquially known as Lipschütz ulcers, represent a distinctive clinical entity characterized by the sudden onset of acute, painful vulvar aphthous ulcers. These lesions, either singular or multiple, exhibit deep, sharply demarcated features with fibrinous coatings or greyish exudate. While AGU typically manifests in non-sexually active adolescent females, it has been associated with various pathogens, including Epstein–Barr virus (EBV) and cytomegalovirus (CMV).
 
Case Presentation
The case that forms the crux of this discussion involves a 37-year-old woman who, a month after recovering from a mild bout of COVID-19, presented with a painful genital ulcer and persistent fever. Of significance, the patient had not engaged in high-risk sexual behavior and had no personal or family history of autoimmune disorders or inflammatory bowel disease. Upon physical examination, multiple asymmetric ulcers with necrotic bases were observed on the labia minora, covered in whitish exudates.
 
Laboratory tests revealed a low lymphocyte count, reduced percentage of lymphocytes, an elevated erythrocyte sedimentation rate, and an increased C-reac tive protein level. Common triggers such as herpes simplex virus, syphilis, EBV, human immunodeficiency virus, and CMV were ruled out through negative serologic test outcomes. The diagnosis, therefore, pointed towards AGU secondary to COVID-19, emphasizing the potential connection between the viral infection and the development of genital ulcers.
 
Discussion on AGU and Differential Diagnoses
AGU, first identified by Lipschütz in 1913, predominantly affects non-sexually active adolescent females and is associated with various pathogens. The diagnostic process involves excluding sexually transmitted infections like Treponema pallidum, herpes simplex virus, and Human Immunodeficiency Virus, as well as non-infectious conditions such as Crohn’s disease, Behçet’s disease, erosive lichen planus, bullous disorders, localized trauma, and tumors. This comprehensive approach to differential diagnosis ensures that clinicians consider a broad spectrum of potential causes when evaluating patients presenting with genital ulcers.
 
COVID-19's Unusual Impact
The association between AGU and COVID-19 adds a new layer of complexity to our understanding of the virus's systemic effects. Recent reports, including the case discussed here, highlight instances where patients were diagnosed with COVID-19 either before the onset of genital ulcers or shortly thereafter. Notably, all cases presented with flu-like symptoms alongside genital ulcers, suggesting a potential link between the viral infection and the development of AGU.
 
The proposed mechanism involves a dysregulation of the immune system and cytokine activation due to systemic illness induced by SARS-CoV-2. Given the virus's propensity to trigger a systemic autoimmune inflammatory response impacting multiple organ systems, the connection between COVID-19 infection and the development of genital ulcers becomes plausible.
 
Treatment Approaches
Managing AGU poses unique challenges, necessitating a tailored approach to address both the acute symptoms and potential recurrences. Treatment modalities include pain management, anti-inflammatory medication, and corticosteroid therapy. While the use of corticosteroids remains controversial, a systematic review suggests that systemic corticosteroids may prolong the disease's duration. However, a retrospective analysis of 26 patients with AGU indicates that corticosteroid therapy effectively resolves acute flare-ups and prevents recurrences.
 
In the context of COVID-19-associated AGU, the case discussed here opted for oral prednisone therapy. The patient exhibited a rapid resolution of symptoms, with the fever subsiding within 24 hours and marked improvement in vulvar edema and ulcers after 14 days of therapy. Notably, four other reported cases of COVID-19-associated AGU have also utilized corticosteroid therapy with favorable outcomes, reinforcing its potential efficacy in managing this unique presentation.
 
Conclusion
In conclusion, the reported case serves as a poignant reminder of the evolving nature of our understanding of COVID-19 and its diverse clinical manifestations. As the global pandemic persists, clinicians must remain vigilant to the potential association between genital ulcers and COVID-19, particularly in the presence of flu-like symptoms.
 
The implications of this rare phenomenon extend beyond diagnosis, emphasizing the importance of timely and effective management. Recognizing the potential link between AGU and COVID-19 can prevent delays in treatment and guide clinicians in implementing appropriate therapeutic interventions. In the current context, where the rapid alleviation of symptoms is crucial, oral steroid therapy, despite its controversies, continues to play a vital role in managing COVID-19-associated AGU.
 
As the medical community navigates the complexities of the ongoing pandemic, staying informed and adaptive to emerging clinical presentations is paramount. The reported case adds another layer to the intricate tapestry of COVID-19's impact, urging healthcare professionals to maintain a comprehensive approach to patient care. By doing so, we can collectively enhance our ability to diagnose, treat, and manage the diverse manifestations of this unprecedented global health crisis.
 
The case report was published in the peer reviewed journal: Clinical, Cosmetic and Investigational Dermatology.
https://www.tandfonline.com/doi/full/10.2147/CCID.S445296
 
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