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Re: Chronic/ ?Recurrent Vaginal Vault UlcerationFrom: Braun, R. Daniel (rbraun@iupui.edu)Mon May 31 07:34:09 1999
VDRL Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN 46202 International Representative for United States OBGYN.net -----Original Message----- From: pmarcus@iupui.edu [SMTP:pmarcus@iupui.edu] Sent: Friday, May 28, 1999 6:27 PM To: Multiple recipients of list OB-GYN-L Subject: Chronic/ ?Recurrent Vaginal Vault Ulceration May 28th, 1999 I have an interesting case of a chronic/?recurrent vaginal ulceration that I would like some assistance with as it even seems to perplex the "old ones" over here. The patient is a 51yo WF G3P2012, status-post a TAH/BSO ('84) secondary to endometriosis, who initially presented to my office 8 months ago complaining of a chronic, painful, vaginal ulceration of 1 year's duration. Approximately, one year prior, she noticed the new onset of deep dysparunia; self-referral to an Ob/Gyn found a "infection" which was treated with PO antibiotic therapy. Upon treatment failure, accompanied by new onset vaginal spotting, pt self-referred to second Ob/Gyn. Gyn Sono, Pap, and biopsy of lesion were all negative - biopsy merely found "chronic ulceration." Pt subsequently underwent laser ablation of the vaginal cuff without success. Of note, an HSV culture of the ulceration, performed at the time of the laser therapy, was postive. Pt then self-referred to me. Initial pelvic exam revealed a quarter-sized lesion, located at the apex of the vaginal vault, which was denuded with rough shaggy borders; course punctation was noted at the edges. The entire lesion was extremely painful to touch. The patient was initially treated with Acyclovir and triple sulfa cream. Upon follow-up in three week's time, near complete resolution was found; additional followup three more weeks found complete resolution. However, two months later, patient returned to clinic reporting a relapse. Physical exam found the same quarter-sized lesion. HSV cultures were again obtained and found to be negative; HSV titers were obtained and found to be positive for IgG only. Pt was begun on Valcyclovir without success. Chronic suppressive therapy with Acyclovir was also unsuccessful. Most recently, the patient underwent a surgical excission of the vaginal vault ulceration. Pathology returned consistent with ...."chronic ulceration and inflamation; no evidence for lichen planus or viral infection." Past medical and surgical histories are non-contributory; Obstetrical history was unremarkable. Gyn history was non-contributory except as above. Except for coitus, when possible, patient places nothing else in vagina. Currently on no medication except ERT. Pre-operative CBC, etc were unremarkable; pt currently declines HIV or other tests of STDs. Any thoughts on the matter? Thank you. Peter S. Marcus MD Indiana University pmarcus@iupui.edu
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