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Case Report/Case Series |

Disseminated Lyme Disease Presenting With Nonsexual Acute Genital Ulcers

Justin J. Finch, MD1; Jenna Wald, MD2; Katalin Ferenczi, MD1; Saima Khalid, MD, MPH3; Michael Murphy, MD1
[+] Author Affiliations
1Department of Dermatology, University of Connecticut School of Medicine, Farmington
2Department of Internal Medicine, University of Connecticut School of Medicine, Farmington
3Generations Health Center, Willimantic, Connecticut
JAMA Dermatol. 2014;150(11):1202-1204. doi:10.1001/jamadermatol.2014.1072.
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Importance  Nonsexual acute genital ulceration (NAGU) is a rare vulvar skin condition typically affecting girls and young women, characterized by acute onset of singular or multiple painful vaginal ulcers. The etiology of this ulcerative dermatosis has not been identified, although it has been associated with systemic infections. To our knowledge, this is the first report of an association with Lyme disease.

Observations  A case of a woman with early disseminated Lyme disease presenting with NAGU is reported. A thorough workup ruled out other causes of genital ulceration, and the ulcers completely resolved after treatment with topical steroids and oral doxycycline.

Conclusions and Relevance  Although the etiology of NAGU is unknown, the vulvar ulcers may result from an exuberant immune response to infection. Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen. In addition to previously reported associations with systemic infection, which are reviewed herein, Lyme disease should be considered in women presenting with acute-onset genital ulcers.

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Figure 1.
Genital Ulcers

The patient presented with these multiple painful ulcers distributed bilaterally on the vulvar labial mucosa.

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Figure 2.
Erythema Migrans

Multiple erythema migrans lesions are distributed on the trunk and arms, representing disseminated (stage 2) Lyme disease.

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