UPP - Department of Dermatology, Dermatopathology Unit
Christina Wahlgren, MD, Arash Radfar, MD, PhD, Laura Ferris, MD, PhD
October 2008 CASE OF THE MONTH
59 yo AAF presents with a 2-3 year history of irritation in the anal and vulvar areas. The areas are painful and occasionally pruritic. Previous treatments include sitz baths, topicort and silvadene without improvement. She denies any lesions in the oral mucosa and has not noted any other skin lesions. Her past medical history is significant for Crohns disease diagnosed 5 years ago treated with a total colectomy 4 years ago.
Physical exam revealed a 2.2 cm erythematous ulcer with a clean base on the left labia majora and a 1.3cm ulcer with clean base on the right labia majora. Erythema of the perianal region was present along with erythema and two 3mm ulcerations on the lateral aspects of the anus.
Punch biopsy of the left labia demonstrated ulcer, dense superficial to deep peri-vascular and interstitial lympho-plasmacytic infiltrate with follicle formation and occasional non-caseating granulomas.