Age: 14.0
Sex: F
Vaccine: COVID19
Symptoms: Urine analysis abnormal, Urine ketone body absent, Urine leukocyte esterase positive, Urobilinogen urine, Vaginal ulceration
Clinical narrative: 28 Aug 2021 (12:30pm) - received vaccine 29 Aug 2021 (8am) - awoke with typical side effects including fever, nausea, chills, body aches, headache, loss of appetite, foggy thinking 30 Aug 2021 (6am) - awoke with vaginal irritation(external), no visible signs of an issue.  Throughout her day at school, she continued to have vaginal irritation but did not identify reason to be concerned.  30 Aug 2021 (8:30pm) - upon entering shower, identified extreme stinging and pain upon water touching vaginal area.  Child went to mother to inspect.  Mother and child identified 2 lesions, one on each inner side of her labia minora.  They were purplish/red blister-like almost looked like blood blisters but very painful to the touch. Mother took her to urgent care where the provider was unsure what they were.  She did not believe they were STDs so instead tested her for Covid19 virus and told her to use Vaseline on them.  Mother and child went home around 2:00am on 31 Aug 2021.  31 Aug 2021 (12:00 pm) - Mother took child to ER.  The pain had increased greatly, and the child was having difficulty urinating without burning or pain. Although the child was NOT sexually active and had never had any sexual interactions, the doctor said he could not rule out an STD.  He conducted a vaginal exam, urinalysis, and drew bloodwork for STD and CBC.  CBC was normal, urinalysis showed 3-5 white blood cells without significant bacteria.  Conducted SBC and Bacteria wet prep indicating few-moderate result, likely due to the use of Vaseline as instructed by the urgent care.  Negative for clue cells yeast, negative for trichomonas.  Doctor prescribed Metrogel 0.75% and sent patient home to await results of the STD testing. STD testing included Chlamydia Trachomatis, Neisseria Gonorrhoeae, Herpes Simplex Virus Culture 1 & 2.  [NOTE: within days, these tests results would ALL return negative results as expected for a non-sexually active child].   1 Sep 2021 (9am):  Mother took child to another ER.  The child was in extreme pain, could barely walk or sit comfortably.  Child was unable to urinate without crying and extreme pain.  Child refused to urinate unless absolutely necessary.  Results from the Chlamydia Trachomatis and Neisseria Gonorrhoeae tests had returned negative but the herpes had not yet returned.  Upon examination, the doctors diagnosed her with Lipschutz ulcers stating that they did not know the cause but that it is rarely present and usually presents when a non-sexually active adolescent has had certain viruses.  The doctors told her to STOP using the Metrogel, there was no bacteria present to be treated.  Doctors prescribed her with multiple medications to include clobetasoL 0.05% ointment, lidocaine 5% ointment, Oxycodone 5mg immediate release tablets (take 2.5mg at a time).  They also conducted a urinalysis and found that she also now had a UTI prescribing her Cephalexin capsules. Child was sent home and told to follow-up with a gynecologists'.    2 Sep 2021 (3pm):  Mother took child to see gynecologists'.  Gynecologist confirmed the diagnosis stating that it is very uncommon.  She prescribed her with an oral steroid to take if the steroid cream did not improve the issues within 48 hours. Told her not to use Vaseline as this could cause bacterial infections.  scheduled a follow-up visit for 8 Sep 2021.   4 Sep 2021: Child began oral steroids because the ulcers had not improved.  UTI pain had decreased by this time.   6 Sep 2021: Child's ulcers had improved and pain had decreased.  No longer taking any pain medication, but still using the lidocaine and steroid creams.  Continued steroid pills prescribed by gynecologist.   30 Aug - 7 Sep:  Child was out of school for these dates. She returned to school on 7 Sep. Over the course of this time, the ulcers had reduced in size and pain became less and less.   8 Sep: Follow-up with gynecologist.  Ulcers were now almost completely gone, pain had subsided.  Doctor ordered the following blood tests: Epstein-Barr Virus Antibody Panel 1, Cytomegalovirus Antibody, IGG Avidity, and CMV Antibody, IGM.  At this visit, the doctor told us her Herpes Simplex 1 & 2 test results were also negative. She stated that if these other 3 blood tests were negative, the only diagnosis for the Lipschutz ulcers would likely be a reaction to receiving the Covid19 vaccine.    17 Sep 2021: Gynecologist notified parent that all blood tests conducted for Epstein-Barr Virus Antibody Panel 1, Cytomegalovirus Antibody, IGG Avidity, and CMV Antibody, IGM all returned NEGATIVE results. There was no conclusive reason for why this child had developed Lipschutz ulcers. The only change had been receiving the Covid19 vaccine on 28 August 2021.