Acute vulvar and upper thigh ulceration associated with primary EBV in an elderly female.

Epstein-Barr Virus (EBV) infection may cause mucocutaneous ulceration during primary or latent infection. Acute vulvar ulceration and prodromal symptoms are known as Lipschütz ulcers, which are typically seen in young females and are associated with multiple infectious etiologies, including primary EBV infection. In elderly patients, latent EBV infections have been associated with lymphoproliferative ulcerations and immunosenescence or immunosuppression.

We present an immunocompetent 77-year-old female with painful vulvar and thigh ulcers and serologies consistent with a primary or reactivated EBV infection. Histological findings were more consistent with Lipschütz ulcers than latent EBV-associated lymphoproliferative ulcerations, suggesting her ulcers were a manifestation of primary EBV, which is extremely rare in elderly populations. Lipschütz ulcerations primarily affect the vulvar areas of the medial and outer surfaces of the labia minora, and latent EBV-associated lymphoproliferative ulcerations present in the mouth, arms, chest, and gastrointestinal tract, whereas our patient’s ulcers were present on her inner thighs and labium majus. In addition, these ulcerations also took longer to resolve than Lipschütz ulcers of previous reports.