Successful Treatment of Lipschütz Ulcer with a JAK Inhibitor, Upadacitinib
Main Article Content
Keywords
Lipschutz ulcer, jak inhibitor, upadacitinib, vaginal ulcers
Abstract
Lipschütz ulcer (LU), is a rare non-venereal diagnosis of exclusion. Typically affecting sexually inactive, young women, LU presents with acute pain and edema along with necrotic ulcerations on the vulva, labia minora, or lower vaginal region. The pathogenesis of LU remain unknown. Published cases suggest that LU may heal spontaneously or with supportive and symptomatic treatment focused on pain relief and inflammation reduction using oral or topical steroids. Here, we present a case of persistent LU that required continuous treatment with a janus kinase (JAK) inhibitor, upadacitinib.
References
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2. Vieira-Baptista P, Lima-Silva J, Beires J, Martinez-de-Oliveira J. Lipschütz ulcers: should we rethink this? An analysis of 33 cases. Eur J Obstet Gynecol Reprod Biol. 2016;198:149-152. doi:10.1016/j.ejogrb.2015.07.016
3. Wolters V, Hoogslag I, Van’ T Wout J, Boers K. Lipschütz Ulcers: A Rare Diagnosis in Women With Vulvar Ulceration. Obstet Gynecol. 2017;130(2):420-422. doi:10.1097/AOG.0000000000002145
4. Miyazawa T, Hayashibe R, Nozawa T, Nishimura K, Ito S. Lipschütz ulcer induced by acute Epstein-Barr virus infection in a young girl. Pediatr Int. 2022;64(1):e15022. doi:10.1111/ped.15022
5. Limão S, Ventura A, Queirós G, Cunha F. Lipschütz ulcer and group A streptococcal tonsillitis. BMJ Case Rep. 2018;2018:bcr2017223579. doi:10.1136/bcr-2017-223579
6. Sadoghi B, Stary G, Wolf P, Komericki P. Ulcus vulvae acutum Lipschütz: a systematic literature review and a diagnostic and therapeutic algorithm. J Eur Acad Dermatol Venereol. 2020;34(7):1432-1439. doi:10.1111/jdv.16161
7. Vismara SA, Lava SAG, Kottanattu L, et al. Lipschütz’s acute vulvar ulcer: a systematic review. Eur J Pediatr. 2020;179(10):1559-1567. doi:10.1007/s00431-020-03647-y
8. Rudolph A, Savage DR. Vulval Aphthous Ulcers in Adolescents Following COVID-19 Vaccination-Analysis of an International Case Series. J Pediatr Adolesc Gynecol. 2023;36(4):383-392. doi:10.1016/j.jpag.2023.03.006
9. Brinca A, Canelas MM, Carvalho MJ, Vieira R, Figueiredo A. Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion. An Bras Dermatol. 2012;87:622-624. doi:10.1590/S0365-05962012000400018
10. Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A. Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection. Eur J Pediatr. 2013;172(8):1121-1123. doi:10.1007/s00431-013-2013-8
11. Sindhuja T, Khaitan BK, Agarwal S, Agarwala S, Bhari N. Lipschutz ulcers in a 4-month-old girl. Pediatr Dermatol. 2022;39(5):827-829. doi:10.1111/pde.15034
12. Haidari G, MacMahon E, Tong CYW, White JA. Genital ulcers: it is not always simplex …. Int J STD AIDS. 2015;26(1):72-73. doi:10.1177/0956462414541241
13. Kotyla PJ, Islam MA, Engelmann M. Clinical Aspects of Janus Kinase (JAK) Inhibitors in the Cardiovascular System in Patients with Rheumatoid Arthritis. Int J Mol Sci. 2020;21(19):7390. doi:10.3390/ijms21197390
14. Tanaka Y. A review of upadacitinib in rheumatoid arthritis. Mod Rheumatol. 2020;30(5):779-787. doi:10.1080/14397595.2020.1782049
15. Padda IS, Bhatt R, Parmar M. Upadacitinib. In: StatPearls. StatPearls Publishing; 2023. Accessed October 5, 2023. http://www.ncbi.nlm.nih.gov/books/NBK572088/
16. Pope J, Sawant R, Tundia N, et al. Comparative Efficacy of JAK Inhibitors for Moderate-To-Severe Rheumatoid Arthritis: A Network Meta-Analysis. Adv Ther. 2020;37(5):2356-2372. doi:10.1007/s12325-020-01303-3
17. Daniele S, Bunick C. JAK Inhibitor Safety Compared to Traditional Systemic Immunosuppressive Therapies. J Drugs Dermatol. 2022;21(12):1298-1303. doi:10.36849/JDD.7187
18. Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. doi:10.1136/bmj.j1909
19. FDA Slaps Restrictions on JAK Inhibitors Over Serious Safety Risks. Published September 1, 2021. Accessed February 19, 2024. https://www.medpagetoday.com/rheumatology/arthritis/94314
20. Rowland K. Short-term use of oral corticosteroids was linked to increased risk for sepsis, VTE, and fractures. Annals of Internal Medicine. 2017;167(4):JC20. doi:https://doi.org/10.7326/acpjc-2017-167-4-020
21. Horton DB, Xie F, Chen L, et al. Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children. American Journal of Epidemiology. 2020;190(3):403-412. doi:https://doi.org/10.1093/aje/kwaa197