In a report on a case series from 3 hospital-based pediatric and adolescent gynecology services, investigators outlined 8 instances of vulvar ulcers developing in 12- to 17-year-olds 1 or 2 days after administration of the Pfizer-BioNTech COVID-19 vaccine. All but 1 female developed the ulcers after the second dose of the vaccine rather than the first, and none had a known history of SARS-CoV-2a or evidence of prior COVID-19 infection. In addition, none of the patients reported recent symptomatic viral illnesses.
Patients first reported systemic symptoms, such as fevers, headache, and myalgias; vulvar symptoms, which included vulvar pain and dysuria, typically developed 2 days after vaccination and peaked within 5 days. Physical exams were consistent with aphthous ulcers, showing violaceous ulcerations with surrounding erythema and necrotic islands.
Symptoms resolved in 10 to 24 days. Five patients required only symptomatic support, while 3 received a course of oral steroids, and 2 a course of antibiotics for positive vulvar cultures. In the patients who received oral steroids, the ulcers resolved without evidence of further lesions in 14 to 21 days. In those who received only symptomatic treatment, lesions fully resolved in 10 to 25 days. Symptomatic treatment included nonsteroidal and anti-inflammatory drugs, acetaminophen, zinc oxide barrier cream, sitz baths, and topical lidocaine.
THOUGHTS FROM DR. FARBER:
Remember this possible cause the next time you see a patient with vulvar ulcers; it can save her (and you) a great deal of trouble. The immunization has also been linked to supraclavicular lymphadenopathy, an entity that previously was almost always pathognomonic for lymphoma.
Sartor RA, Lawson A, Moncada-Madrazo M, Altchek C, Vash-Margita A, Cron J. Vulvar aphthous ulcers in perimenarchal adolescents after COVID-19 vaccination: a multicenter case series. J Pediatr Adolesc Gynecol. 2023; S1083-3188(23)00003-7. doi:10.1016/jpag2023.01.003