VULVITIS CIRCUMSCRIPTA PLASMACELLULARIS

Abstract

A 56‐year‐old woman reported that an erythematous lesion, accompanied by severe burning, had appeared on the left labium minus about 2 years earlier. She had treated herself with topical deoxymethasone and estrogen topical medications that temporarily relieved the subjective synnptoms, but did little to help the clinical manifestations. The patient's history revealed an adnexectomy and ovariectomy at age 40 after an ectopic pregnancy and a left saphenectomy for ectatic varicose veins at age 54. We noted a bright red, shiny, almost lacquerlike lesion with clearly defined edges on the left labium minus that started from the external vaginal orifice and extended over half of the labium (Fig. 1). The lesion was not infiltrated and there was no inguinal lymphoadenopathy. Routine blood chemistry was normal and culture tests for bacteria and fungi were negative. The histologic examination showed a basically healthy epidermis with the exception of a focal reduction of the granular layer, a flattening of the dermoepidermal junction, capillary vasodilatation in the superficial dermis, and an infiltrate consisting of granulocytes, lymphocytes, and numerous plasma cells (Fig. 2). Direct immunofluorescence (DIF) performed with antigammaglobulin antiserum revealed numerous cell elements that tested positive with anti‐lgA antiserum with cytoplasmatic fluorescence at the dermal and subjunctional level (Fig. 3). On the basis of the clinical and histopathologic data we diagnosed a chronic circumscribed plasmacellular vulvitis, or Zoon's vulvitis. Excellent results were obtained after 3 months of topical treatment with cyclosporine.