Abstract
Discussion Forum (0)
Case Study
Introduction:
Zoon's vulvitis is an extremely rare but known inflammatory disorder of the female genital tract, typically described as involving the vulva. It is characterized by erythematous mucosal lesions that are associated with burning, dysuria, dyspareunia, or no symptoms at all. Histologically, the disease consists of thinned epithelium with infiltration of plasma cells in the underlying dermis. There are few case reports demonstrating predominately vaginal symptoms in the literature.
Case Description: The patient is a 53-year-old postmenopausal female presenting for evaluation of a vaginal pinching sensation with movement. Patient endorsed history of pelvic inflammatory disease, abnormal pap smears, and uterine artery embolization for leiomyomas. Infectious workup was negative. On exam, the vulva appeared normal; the vaginal mucosa was notable for bilateral flat, shiny, erythematous, miniscule macules covering an approximately 1cm area of the side wall located approximately 3cm cephalad of the introitus. This area demonstrated focal tenderness on palpation. Colposcopic biopsies returned with plasmacytosis mucosae consistent with Zoon's vaginitis. The patient was treated with external clobetasol ointment and hydrocortisone vaginal suppositories with moderate improvement in her symptoms.
Discussion: Female genital tract lesions carry a broad differential including infectious, immunologic, and malignant causes. In this patient, the differential was most concerning for atrophic vaginitis suggesting treatment with topical estrogen. However, histological diagnosis of this plasma cell disorder directed treatment with steroid therapy and provided relief of this patients symptoms as well as allayed her concerns for recurrent sexually transmitted infections.
Introduction:
Zoon's vulvitis is an extremely rare but known inflammatory disorder of the female genital tract, typically described as involving the vulva. It is characterized by erythematous mucosal lesions that are associated with burning, dysuria, dyspareunia, or no symptoms at all. Histologically, the disease consists of thinned epithelium with infiltration of plasma cells in the underlying dermis. There are few case reports demonstrating predominately vaginal symptoms in the literature.
Case Description: The patient is a 53-year-old postmenopausal female presenting for evaluation of a vaginal pinching sensation with movement. Patient endorsed history of pelvic inflammatory disease, abnormal pap smears, and uterine artery embolization for leiomyomas. Infectious workup was negative. On exam, the vulva appeared normal; the vaginal mucosa was notable for bilateral flat, shiny, erythematous, miniscule macules covering an approximately 1cm area of the side wall located approximately 3cm cephalad of the introitus. This area demonstrated focal tenderness on palpation. Colposcopic biopsies returned with plasmacytosis mucosae consistent with Zoon's vaginitis. The patient was treated with external clobetasol ointment and hydrocortisone vaginal suppositories with moderate improvement in her symptoms.
Discussion: Female genital tract lesions carry a broad differential including infectious, immunologic, and malignant causes. In this patient, the differential was most concerning for atrophic vaginitis suggesting treatment with topical estrogen. However, histological diagnosis of this plasma cell disorder directed treatment with steroid therapy and provided relief of this patients symptoms as well as allayed her concerns for recurrent sexually transmitted infections.
Case Study
Introduction:
Zoon's vulvitis is an extremely rare but known inflammatory disorder of the female genital tract, typically described as involving the vulva. It is characterized by erythematous mucosal lesions that are associated with burning, dysuria, dyspareunia, or no symptoms at all. Histologically, the disease consists of thinned epithelium with infiltration of plasma cells in the underlying dermis. There are few case reports demonstrating predominately vaginal symptoms in the literature.
Case Description: The patient is a 53-year-old postmenopausal female presenting for evaluation of a vaginal pinching sensation with movement. Patient endorsed history of pelvic inflammatory disease, abnormal pap smears, and uterine artery embolization for leiomyomas. Infectious workup was negative. On exam, the vulva appeared normal; the vaginal mucosa was notable for bilateral flat, shiny, erythematous, miniscule macules covering an approximately 1cm area of the side wall located approximately 3cm cephalad of the introitus. This area demonstrated focal tenderness on palpation. Colposcopic biopsies returned with plasmacytosis mucosae consistent with Zoon's vaginitis. The patient was treated with external clobetasol ointment and hydrocortisone vaginal suppositories with moderate improvement in her symptoms.
Discussion: Female genital tract lesions carry a broad differential including infectious, immunologic, and malignant causes. In this patient, the differential was most concerning for atrophic vaginitis suggesting treatment with topical estrogen. However, histological diagnosis of this plasma cell disorder directed treatment with steroid therapy and provided relief of this patients symptoms as well as allayed her concerns for recurrent sexually transmitted infections.
Introduction:
Zoon's vulvitis is an extremely rare but known inflammatory disorder of the female genital tract, typically described as involving the vulva. It is characterized by erythematous mucosal lesions that are associated with burning, dysuria, dyspareunia, or no symptoms at all. Histologically, the disease consists of thinned epithelium with infiltration of plasma cells in the underlying dermis. There are few case reports demonstrating predominately vaginal symptoms in the literature.
Case Description: The patient is a 53-year-old postmenopausal female presenting for evaluation of a vaginal pinching sensation with movement. Patient endorsed history of pelvic inflammatory disease, abnormal pap smears, and uterine artery embolization for leiomyomas. Infectious workup was negative. On exam, the vulva appeared normal; the vaginal mucosa was notable for bilateral flat, shiny, erythematous, miniscule macules covering an approximately 1cm area of the side wall located approximately 3cm cephalad of the introitus. This area demonstrated focal tenderness on palpation. Colposcopic biopsies returned with plasmacytosis mucosae consistent with Zoon's vaginitis. The patient was treated with external clobetasol ointment and hydrocortisone vaginal suppositories with moderate improvement in her symptoms.
Discussion: Female genital tract lesions carry a broad differential including infectious, immunologic, and malignant causes. In this patient, the differential was most concerning for atrophic vaginitis suggesting treatment with topical estrogen. However, histological diagnosis of this plasma cell disorder directed treatment with steroid therapy and provided relief of this patients symptoms as well as allayed her concerns for recurrent sexually transmitted infections.
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