Pyoderma gangrenosum of the vulva treated with mycophenolate mofetil and infliximab

Recalcitrant vulvar pyoderma gangrenosum successfully treated with mycophenolate mofetil

“…Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis characterized by recurrent, painful, ulcerations. 1 Treatment typically involves anti-inflammatory agents, including corticosteroids, calcineurin inhibitors, antimetabolites, and TNF-alpha inhibitors. 1 We present a case of vulvar PG, mimicking vulvar cellulitis and refractory to steroids, with successful response to mycophenolate mofetil (MM).…”

“… 1 Although most commonly found on the lower extremities and frequently associated with systemic inflammatory conditions, several reports have demonstrated isolated PG affecting mucocutaneous regions, including the vulva. 1 , 2 …”

“…First line therapy includes corticosteroids 1 followed by systemic immunosuppressants. Infliximab is efficacious in treating vulvar PG, 1 but we were unable to initiate infliximab due to patient preference and insurance limitations. In PG, MM reduces ulcer size with a favorable side-effect profile.…”

“…1,2 PG is a diagnosis of exclusion, and active infection, malignancy, and underlying disease should be investigated. 1 Our patient's vulvar ulcerations were initially treated as cellulitis. This case highlights that the differential for vulvar swelling and erythema should also include early PG.…”

“…1 Although most commonly found on the lower extremities and frequently associated with systemic inflammatory conditions, several reports have demonstrated isolated PG affecting mucocutaneous regions, including the vulva. 1,2 PG is a diagnosis of exclusion, and active infection, malignancy, and underlying disease should be investigated. 1 Our patient's vulvar ulcerations were initially treated as cellulitis.…”