Vulvovaginal pyoderma gangrenosum in association with rituximab

Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative skin disease with 4 major clinical forms: ulcerative, vesicular-bullous, pustular, and superficial granulomatous/vegetative. Lesions are painful and most frequently occur on the lower extremities, although they can occur anywhere, including mucus membranes and peristomal sites. The pathophysiology of PG is speculative, but proposed mechanisms include loss of innate immune regulation or altered neutrophil chemotaxis.1 Biopsies most characteristically find neutrophilia, and the concept of neutrophil dysregulation has also been supported by the clinical response that may be seen with the use of antineutrophilic agents including colchicine and dapsone.