title: Superficial granulomatous pyoderma of the vulva in a patient receiving maintenance rituximab (MabThera) for lymphoma.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Dermatology, Broadgreen Hospital, Liverpool, UK. maeve.walsh@rlbuht.nhs.uk
authors.forename: Maeve
authors.initials: M
authors.lastname: Walsh
authors.forename: Niamh
authors.initials: N
authors.lastname: Leonard
authors.forename: Hazel
authors.initials: H
authors.lastname: Bell
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D000069283:Rituximab; D014844:Vulva / Q000473:pathology*; D014845:Vulvar Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab