Gastrointestinal: A rare case of concurrent vulvar Crohn's disease and pyoderma gangrenosum

Abstract

Figure 1 (a) Vulvar exam under anesthesia revealed a chronic perineal wound with pink granulation tissue, approximately 4 cm in length, without drainage or bleeding. Deep ulcerations bilaterally between labia minora and labia majora in the peri-clitoral region noted with overlying fibrinous exudate and friability. Ulcerations noted at the base of bilateral labia majora extending into the posterior fourchette, also with fibrinous exudate and friability, noted to have rounded and raised borders. (b) Vulvar region with significant interval improvement in labial swelling with decreased size of linear ulceration on the left side of the vulva. (c) Squamous epithelium of the vulva with ulceration, granulation tissue, and marked granulomatous inflammation. Negative stains for acid-fast Bacilli (AFB) smear, periodic acid-Schiff (PAS), CMV, and HSV. (d) Vulvar biopsies with pathology consistent with skin ulceration with neutrophilic dermatosis and lymphocytic infiltrates consistent with pyoderma gangrenosum. Negative stains for Fite, PAS, and GMS.