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Superficial Granulomatous Pyoderma of the Vulva in a Patient Receiving Maintenance Rituximab (MabThera) for Lymphoma

Walsh, Maeve MBChB, MRCP1; Leonard, Niamh MB, FRCPath2; Bell, Hazel MBChB, MSc, FRCP, DRCOG1

Journal of Lower Genital Tract Disease: April 2011 - Volume 15 - Issue 2 - p 158-160
doi: 10.1097/LGT.0b013e3181eb30ff
Case Reports

Background. Vulval ulceration can be caused by a wide variety of etiological factors including bacterial and viral infections, granulomatous disorders, and malignancy. Superficial granulomatous pyoderma (SGP) is a variant of pyoderma gangrenosum. It is characterized by localized ulcerative lesions that may be precipitated by surgery. We report a case of vulval SPG in an immunocompromised patient.

Case. A 51-year-old woman presented with a 6-week history of severe vulval pain, bleeding, and rapidly progressing ulceration. She had a previous history of relapsed follicular non-Hodgkin lymphoma and was currently receiving regular MabThera (Welwyn Garden City, Hertfordshire, UK). Examination revealed deep ulceration involving the entire vulva and extending into the vagina with areas of necrosis. Histological examination showed ulceration with sparse granulomas and eosinophils. The clinical and histological findings confirmed a diagnosis of SGP.

Conclusions. Vulval ulceration in an immunocompromised patient has a broad differential diagnosis. The possibility of a granulomatous condition such as SGP must always be considered.

A case of vulval superficial granulomatous pyoderma in an immunocompromised patient.

1Department of Dermatology, Broadgreen Hospital; and 2Department of Histopathology, Royal Liverpool University Hospital, Liverpool, UK

Reprint requests to: Maeve Walsh, MBChB, MRCP, Department of Dermatology, Broadgreen Hospital, Thomas Dr, Liverpool, L14 3LB, UK. E-mail:

©2011The American Society for Colposcopy and Cervical Pathology