Background: Two cases of genital ulcerations caused by Epstein-Barr virus have been reported previously, one in a sexually active 23-year-old and another in a 14-year-old practicing cunnilingus.
Case: We report a case of Epstein-Barr virus genital ulcerations in a premenarcheal virgin. Her systemic symptoms were atypical for mononucleosis. Necrotizing genital ulcerations preceded pharyngitis and oral lesions. Cervical adenopathy, fever, and splenomegaly never developed despite serologic evidence of acute mononucleosis.
Conclusion: Genital ulcerations can be the initial manifestation of Epstein-Barr virus in adolescents who are neither sexually active nor immunocompromised.