Cytolytic vaginosis: a case report

Abstract

Introduction: The vaginal flora consists in different microorganisms that promote a balanced interaction between the vaginal microbiome, hormonal status, products of microbial metabolism, and the host’s immune response. The instability of the vaginal ecosystem can lead to vulvovaginitis, which is a reason for frequent consultation in primary health care, as bacterial vaginosis, vaginal candidiasis, and trichomoniasis, are responsible for most diagnoses. There are other pathologies with similar presentations but less frequent. However, these are not considered to result in wrong diagnoses and treatments, such as cytolytic vaginosis.

Case description: A 20-year-old woman complained of abundant vaginal discharge, use of daily sanitary pads, itching, and odor change within one month of evolution. The physical examination highlights the redness of the external lips and vaginal introitus, as abundant, non-adherent, non-airy, and odorless mucous discharge. Cervicovaginal cytology was performed on a slide that showed inflammation and was negative for intraepithelial lesions or malignancies. A culture of vaginal exudate was requested, which showed abundant epithelial cells and numerous Doderlein bacilli. Considering the presented case, the most likely diagnosis of cytolytic vaginosis was assumed. Recommendations were given, sitz baths with sodium bicarbonate were prescribed, and the patient remained asymptomatic.

Comment: In the case of a patient with symptoms of vaginal discharge and itching, the first diagnostic hypothesis should consider the prevalence of the most frequent vulvovaginal infections. However, the culture of the exudate allowed us to exclude the presence of bacteria, fungi, and parasites. The patient’s symptoms and physical examination findings are characteristic of cytolytic vaginosis. The culture of the exudate confirmed the suspicion, and the appropriate diagnosis and treatment were performed. This case is intended to alert clinicians to the existence of this pathology that can often go unnoticed, compromising women’s health.