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Vaginal Agglutination: Chronic Graft-Versus-Host Disease Mimics Lichen Planus

Hundley, Andrew F. MD1; Magro, Cynthia MD2; Bartholomew, Deborah MD1

Journal of Lower Genital Tract Disease: January 2011 - Volume 15 - Issue 1 - p 71-74
doi: 10.1097/LGT.0b013e3181e54061
Case Reports

Background. Graft-versus-host (GVH) disease is a common problem in transplant patients, whereas vulvovaginal gingival syndrome is an uncommon and severe variant of lichen planus characterized by erosions of characteristic mucosal surfaces, with frequent vaginal involvement, resulting in scarring or stricture formation. Both conditions have the potential to present with similar clinical pictures.

Case. We report the history, evaluation, and treatment of a woman who had recently undergone stem cell transplant for acute lymphoblastic leukemia who presented with vaginal agglutination. A clinical diagnosis of erosive lichen planus versus chronic GVH disease was considered.

Conclusions. Lichen planus and GVH disease are both inflammatory processes, which can present with a range of clinical conditions. Each may result in the development of irritative symptoms and erosive lesions on mucosal surfaces. Although lichen planus is a well-defined dermatosis, GVH disease is an iatrogenic process. We report the case history of a patient with erosive vulvovaginal lesions with scarring, likely caused by GVH disease, which mimicked erosive vulvovaginal lichen planus. Although the clinical presentation and treatment of these 2 entities are similar, this case demonstrates the subtle diagnostic difference between the 2 diseases.

The differential for vaginal agglutination should include graft-versus-host disease, which may mimic lichen planus.

1The Ohio State University College of Medicine, Columbus, OH; and 2Weill Medical College of Cornell, New York, NY

Correspondence to: Andrew F. Hundley, MD, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, 395 W 12th Ave Room 522, Columbus, OH 43210-1267. E-mail:

Presented at the Inaugural Meeting of the North American Chapter of the International Society for the Study of Vulvovaginal Disease, March 15, 2009, Houston, TX.

©2011The American Society for Colposcopy and Cervical Pathology