Extensive Nonsexually Acquired Acute Genital Ulceration in a 2-Year-Old Girl: A Diagnostic Challenge.

Acute nonsexually acquired genital ulceration (NSAGU) is uncommon in young children and presents a substantial diagnostic challenge because of its broad differential diagnosis. A 2-year-old girl presented with extensive bilateral vulvar ulceration and edema without systemic symptoms. Comprehensive evaluation excluded several infectious etiologies, sexually transmitted infections, and other major causes, although lesion-based herpes simplex virus testing was unavailable. The ulcers gradually resolved over 38 days following oral acyclovir, a single dose of ceftriaxone, and supportive care. Based on the clinical course and exclusion of alternative diagnoses, the presentation was considered most compatible with NSAGU, although a definitive infectious trigger could not be identified. This case highlights the importance of a broad diagnostic evaluation and cautious interpretation when definitive virologic testing is unavailable.