Erythema nodosum: A harbinger of Lipschutz ulceration?

Diagnosis of genital ulcers can be challenging. There are various differential diagnoses including sexually and non-sexually transmitted infections, autoimmune conditions, drug reactions, and as a manifestation of systemic illness. Lipschutz ulcer is a non-venereal genital ulcer, probably an underdiagnosed condition, characterized by acute painful necrotic vulval ulcerations. We report the case of a 45-year-old female with a recurrent history of erythema nodosum (EN) who presented with vulvar ulcers two weeks after an upper respiratory tract infection. Other possible venereal and non-venereal etiologies were ruled out and lesions healed with no sequelae. Through this case report we attempt to increase awareness regarding this uncommon condition and its possible relation to EN, an entity with the same pathophysiology. The diagnostic workup for genital ulcers is extensive, but when correctly identified, treatment and reassurance provide great comfort to the patient.