title: Disseminated Lyme disease presenting with nonsexual acute genital ulcers.
abstract: OBJECTIVE
  Nonsexual acute genital ulceration (NAGU) is a rare vulvar skin condition typically affecting girls and young women, characterized by acute onset of singular or multiple painful vaginal ulcers. The etiology of this ulcerative dermatosis has not been identified, although it has been associated with systemic infections. To our knowledge, this is the first report of an association with Lyme disease.
  
  
  METHODS
  A case of a woman with early disseminated Lyme disease presenting with NAGU is reported. A thorough workup ruled out other causes of genital ulceration, and the ulcers completely resolved after treatment with topical steroids and oral doxycycline.
  
  
  CONCLUSIONS
  Although the etiology of NAGU is unknown, the vulvar ulcers may result from an exuberant immune response to infection. Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen. In addition to previously reported associations with systemic infection, which are reviewed herein, Lyme disease should be considered in women presenting with acute-onset genital ulcers.
authors.affiliation: Department of Dermatology, University of Connecticut School of Medicine, Farmington.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Finch
authors.affiliation: Department of Internal Medicine, University of Connecticut School of Medicine, Farmington.
authors.forename: Jenna
authors.initials: J
authors.lastname: Wald
authors.affiliation: Department of Dermatology, University of Connecticut School of Medicine, Farmington.
authors.forename: Katalin
authors.initials: K
authors.lastname: Ferenczi
authors.affiliation: Generations Health Center, Willimantic, Connecticut.
authors.forename: Saima
authors.initials: S
authors.lastname: Khalid
authors.affiliation: Department of Dermatology, University of Connecticut School of Medicine, Farmington.
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline