Vulvar Aphthous Ulcer Following Pfizer-BioNTech COVID-19 Vaccine – A Case Report

Case- A 14-year-old patient reported vulvar pain and visible lesion. Exam findings were consistent with vulvar aphthous ulcers. Two days prior to the onset of her symptoms she received her second Pfizer-BioNTech COVID-19 vaccine. The evening of vaccine administration, she experienced several hours duration of fatigue, muscle aching and insomnia but had otherwise been recently healthy and testing for common viral associations of vulvar ulcers was negative.

Summary and conclusion- Vaccination, in general, has been associated with mucosal side-effects and oral ulceration has been reported in subjects who received Pfizer-BioNTech COVID-19 vaccine. It is reasonable to hypothesize that vulvar ulceration may be caused by a similar mechanism and should be considered a rare side effect of this vaccine.

Introduction-

Vaccination against SARS-CoV-2 is a vital tool for ending the current pandemic. With the advent of novel vaccines and wide-spread administration, information on efficacy and side-effect profiles continues to grow. Additionally, the circulation of misinformation about vaccine safety, particularly gynecologic side-effects, appears to be growing in parallel. Patients who are concerned about the possible side-effects of a novel vaccine may be unwilling to take it. It is imperative that the medical community reports all manifestations of possible side-effects from the vaccines. Though it is unclear if side-effect reporting will increase vaccine uptake, explanation of side-effects may be useful to assure the public they are understandable, rare and self-limited.

Case-

A 14-year-old girl with no history of prior sexual activity complained of new-onset burning pain at the vaginal introitus. Upon onset of pain, her mother helped to examine the patient at home and noted three distinct lesions with yellow covering and surrounding erythema. Over the course of the next three days, the patient’s symptoms worsened so that she reported not being able to sit down or walk without exquisite pain. Appointment was made in the gynecology clinic for consultation and, upon exam, she was noted to have three shallow-based ulcerations on the inferior, medial edges of the labia minora. The ulcers were purple-pink in color with sloughing yellow roof at the core and surrounding edema. The largest lesion, on the right side, was noted to be approximately 12mm in maximum diameter. No vesicles and no other vulvar or perianal skin changes were noted. Oral and pharyngeal exams were normal. No cervical or inguinal lymphadenopathy was noted. The patient did not have a known history of SARS-CoV-2 viral infection.