DESTIN, FLA. Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.
"You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV," Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.
Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.
"Of course, sexually transmitted diseases were first and foremost on everybody's mind," she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.
When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.
All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.
Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.