Background: Lipschütz ulcers are characterized by painful vulvar ulceration, most commonly in young women. Because these lesions are so rarely seen, the diagnosis can be challenging.
Case: An 18-year-old woman, without any prior sexual activity, developed painful blue vulval lesions. These became necrotizing ulcers, and she began antiviral therapy for presumptive herpes infection. Herpes cultures, however, were negative. Serology consistent with a recent Epstein-Barr virus infection resulted in a diagnosis of Lipschütz ulcers.
Conclusion: Lipschütz ulcers, associated with acute Epstein-Barr virus infection or other viral and bacterial infections, are a type of nonsexually transmitted vulvar ulceration. It is important to avoid selective attention to sexually transmitted infections as the etiology to avoid unnecessary antiviral therapy and immune suppressants. By considering other etiologies, the patient will be spared potentially embarrassing persistent questioning about her sexual history.