Department of obstetrics and gynecology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Department of Pathology, All India Institute of Medical Sciences, Bathinda, India.
J Med Case Rep. 2021 Feb 26;15(1):97. doi: 10.1186/s13256-021-02720-w.
Lichen planus is a rare autoimmune disease primarily affecting the skin and mucous membranes of the oral mucosa, vulva, and vagina. Diagnosis is difficult and often delayed as the clinicians do not associate the oral symptoms with the genital symptoms. This has a negative impact on the out-of-pocket expenditure and quality of life of the patients. We report this case, as only anecdotal cases have been reported so far from a developing country such as India. We highlight the unindicated hysterectomy that the patient had undergone because of lack of awareness regarding this condition. Our case report also highlights the importance of the multidisciplinary team approach to optimize outcomes and avoid unnecessary morbidity to such patients.
We report a North-Indian patient with oro-vaginal-vulvar lichen planus who presented to us with complaints of recurrent vulvovaginal symptoms for the last 5 years. She had been previously treated with multiple courses of antibiotics, antifungals, and topical steroids over the course of 3 years and finally offered laparoscopic-assisted vaginal hysterectomy (LAVH) by a private practitioner but got no relief. She also had complained of oral symptoms in the form of a burning sensation after eating spicy food, but did not seek any treatment for this. After multidisciplinary team discussion, a final diagnosis of oro-vaginal-vulvar lichen planus was made at our institute based on the clinical and histopathological findings. The patient was immediately started on oral prednisolone to which she responded with improvement in her symptoms.
Lichen planus is a chronic painful condition with significant impact on the quality of life. Women often suffer for several years before an accurate diagnosis is made. Treatment is challenging and needs to be individualized with a multidisciplinary approach to prevent progressive anatomical distortion and associated morbidity.
扁平苔藓是一种罕见的自身免疫性疾病，主要影响皮肤和口腔黏膜、外阴和阴道的黏膜。由于临床医生不会将口腔症状与生殖器症状联系起来，因此诊断困难且常常延误。这对患者的自费支出和生活质量产生了负面影响。我们报告了这个病例，因为迄今为止，只有来自印度等发展中国家的零星病例报告。我们强调了该患者因缺乏对这种疾病的认识而进行的不必要的子宫切除术。我们的病例报告还强调了多学科团队方法的重要性，以优化结果并避免此类患者的不必要发病率。
我们报告了一名来自印度北部的口腔-阴道-外阴扁平苔藓患者，她因过去 5 年来反复出现外阴阴道症状而就诊。她曾在 3 年内接受过多次抗生素、抗真菌药和局部类固醇治疗，最后被一位私人医生建议行腹腔镜辅助阴道子宫切除术（LAVH），但未得到缓解。她还曾抱怨口腔症状，即进食辛辣食物后出现烧灼感，但未对此进行任何治疗。经过多学科团队讨论，我们在本院根据临床和组织病理学发现最终诊断为口腔-阴道-外阴扁平苔藓。患者立即开始口服泼尼松龙治疗，症状得到改善。
扁平苔藓是一种慢性疼痛性疾病，对生活质量有重大影响。女性通常在得到准确诊断前要忍受数年的病痛。治疗具有挑战性，需要个体化和多学科方法，以预防进行性解剖学变形和相关发病率。
