Ligneous cervicovaginitis.

Ligneous inflammation is a rare systemic disorder which can affect the conjunctiva, the female genital tract, the upper and lower respiratory system, the gingiva, and the ears [1–3]. The ocular mucosa is the most common site involved. It can be diagnosed by the examination of biopsy material histopathologically. In histopathologic examination, chronic inflammatory changes, which contain amorphous, eosinophilic, amyloid-like subepithelial fibrin deposits, are encountered. Amorphous deposits include fibrillar material consistent with fibrin [4]. These eosinophilic fibrin deposits are periodic acid–Schiff (PAS)-positive material accompanied by inflammatory cellular infiltration. Ligneous inflammation is a recurrent, chronic inflammatory disorder for which curative treatment is not available. Most gynecologists are unfamiliar with this diagnosis, and lack of awareness of this unusual entity can cause diagnostic difficulties [4]. Autosomal recessive inheritance is said to be responsible for the disorder, and there are also familial cases [5]. Recently, plasminogen deficiency has been found to be responsible for ligneous changes because of an inability to remove fibrin which is deposited in injured mucosal tissue [6,7]. A 22-year-old married woman presented at our gynecology clinic with dyspareunia and dysmenorrhea. She had also been suffering from primary infertility for two years. She complained about a white vaginal discharge which included white plaques, and her symptoms worsened prior to her menses. On gynecologic examination, the cervix was found to be deformed and there were hard white plaques, which showed inflammatory reactions, at the vaginal fornixes and around the cervix (Figures 1 and 2). In the medical investigation of infertility, her basal hormones (follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, prolactin levels on the third day of the menstrual cycle) were normal. Her husband’s spermiogram was normal, and hysterosalpingography revealed patent tubes and adequate uterine cavity. Transvaginal ultrasonography was conducted, and the uterus, ovaries and endometrium were found to be normal. Because of her vaginal discharge, cervicovaginal culture, fresh examination and smear staining were conducted. There was no evidence of Candida and Trichomonas, and no clue cell was observed. The whiff test and Chlamydia antigen test were negative, and *Correspondence to: Dr Sunduz Ozlem Altinkaya, Oguzlar Mahalle, 39 Sokak, Cagdas Apt. 3/6, Balgat, 06520 Ankara, Turkey. E-mail: [email protected] Accepted: February 14, 2008 Figure 1. Ligneous plaques (arrow) around the cervix.