Differential Diagnosis
- Single most likely diagnosis
- Lichen planus: This condition is characterized by the presence of white plaques on the mucous membranes, including the oral and vaginal mucosa, as well as the lacelike appearance of the gingivae. The patient's symptoms of vulvar pain, odorless vaginal discharge, and pruritus, along with the physical examination findings of glazed, brightly erythematous erosions on the labia minora and a friable, erythematous vaginal epithelium, are consistent with lichen planus. The presence of painful oral lesions that did not respond to topical anesthetics also supports this diagnosis.
- Other Likely diagnoses
- Lichen sclerosus: This condition can cause vulvar pain, pruritus, and scarring, leading to a stenotic vaginal introitus. While the patient's symptoms and physical examination findings could be consistent with lichen sclerosus, the presence of oral lesions and the characteristic appearance of the gingivae make lichen planus a more likely diagnosis.
- Vulvar dermatitis: This condition can cause vulvar pain, pruritus, and erythema, but it would not typically cause the oral lesions or the characteristic mucous membrane findings seen in this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vulvar cancer: Although the patient's symptoms and physical examination findings are more consistent with a benign condition, vulvar cancer must be considered in the differential diagnosis, particularly in a postmenopausal woman. A biopsy would be necessary to rule out this diagnosis.
- Invasive fungal infection: In immunocompromised patients, invasive fungal infections can cause vulvar pain, pruritus, and erythema. While this diagnosis is unlikely in this patient, it must be considered due to the potential for severe morbidity and mortality.
- Rare diagnoses
- Pemphigus vulgaris: This is a rare autoimmune condition that can cause blistering lesions on the skin and mucous membranes. While the patient's symptoms and physical examination findings could be consistent with pemphigus vulgaris, the lack of blistering lesions and the characteristic appearance of the gingivae make this diagnosis less likely.
- Behçet's disease: This is a rare condition that can cause oral and genital ulcers, as well as other systemic symptoms. While the patient's symptoms could be consistent with Behçet's disease, the lack of other systemic symptoms and the characteristic mucous membrane findings make this diagnosis less likely.