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Mycoplasma pneumoniae: A Rare Cause of Vulvar Ulcers or an Undiagnosed One?

Vieira-Baptista, Pedro MD1; Machado, Luísa MD1; Costa, Ana Rosa MD1; Beires, Jorge PhD1; Martinez-de-Oliveira, José PhD2

Journal of Lower Genital Tract Disease: July 2013 - Volume 17 - Issue 3 - p 330–334
doi: 10.1097/LGT.0b013e3182710896
Case Reports

Objectives: Acute vulvar ulcers are quite common, and often, an etiological diagnosis cannot be achieved. This article reports 3 cases of vulvar ulcers in adult women infected with Mycoplasma pneumoniae. The authors were able to find only one similar report in the literature.

Material and Methods: Two women in their third decade of life and 1 in the fourth presented to the hospital with acute and intense vulvar pain. Two of them reported oropharyngeal symptoms in the preceding days. All 3 presented with extensive, painful, and destructive vulvar ulcers. A standard protocol was applied, including samples taken from the ulcer (microbiology and polymerase chain reaction) and blood drawn for serological examination and liver function testing. All 3 had the remarkable finding of a positive immunoglobulin G (IgG) and IgM for M. pneumonia (in one of the cases, IgM was initially inconclusive but turned to positive when repeated 2 weeks later). One patient had an extensive destruction of one labium minus, requiring surgical reconstruction.

Results: Two of them were treated with antibiotics, and one was not. However, in fact, all 3 healed in a similar period, making it probable that this kind of medication is not helpful.

Conclusions: M. pneumoniae might be associated with some cases of vulvar ulcers and should always be tested in this context. Probably, antibiotic treatment is not helpful, even when this agent is identified as the possible causal agent of vulvar ulcers.

Serology for Mycoplasma pneumoniae should be tested in women presenting with vulvar ulcers, especially if preceded by respiratory symptoms.

1Serviço de Ginecologia e Obstetrícia, Hospital de São João, Porto; and 2Faculdade de Ciências da Saúde, Universidade da Beira Interior and Departamento de Saúde da Criança e da Mulher, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal

Reprint requests to: Pedro Vieira Baptista, MD, Avenida Menéres, n° 234, bloco 16, 4° direito, 4450-189 Matosinhos, Portugal. E-mail: pedrovieirabaptista@gmail.com.

The authors did not receive any grant for the elaboration of this article and have no conflicts of interest to declare.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology