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April 1, 2008

Multiple Painful Vaginal Ulcerations—Diagnosis

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Arch Dermatol. 2008;144(4):547-552. doi:10.1001/archderm.144.4.547-f

The biopsy specimens revealed ulcerated skin with a dense infiltrate of mononuclear cells in the superficial dermis, some of which had a high nuclear-cytoplasmic ratio. No organisms were seen on Gram or Warthin-Starry stains or on staining with periodic acid–Schiff after diastase digestion. Donovan bodies were not noted. In situ hybridization for EBV-associated RNA showed positive staining of a few infiltrating lymphocytes.

The results of gonorrhea polymerase chain reaction (PCR), chlamydia PCR, human immunodeficiency virus viral load PCR, VDRL, antinuclear antibody, perinuclear antineutrophil cytoplasmic antibody, and circulating antineutrophil cytoplasmic antibody tests were all negative. Coagulation studies demonstrated no abnormalities. Herpes simplex virus, bacterial tissue, fungal tissue, and bacterial throat cultures showed no growth. The results of a monospot test were positive. Serologic tests for EBV revealed elevated titers of IgM viral capsid antigen, IgM nuclear antigen, and IgG early antigen. Titers of IgG nuclear antigen were undectable. This pattern is consistent with early EBV infection. By the time of reexamination 1 week later, the patient's vaginal ulcerations had spontaneously resolved.

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