Recurrent Genital Herpes Triggering Ulcerative Pyoderma Gangrenosum

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that presents as painful, rapidly growing skin ulcers with undermined edges and a violaceous, ragged border at the periphery and is non-responsive to conventional treatments. The average onset age is in the fourth decade, with a female preponderance. Genital PG is uncommon and may present singly or coexist with common sexually transmitted genital ulcerative diseases, which causes delays in the diagnosis and treatment of genital PG, thereby adding to the morbidity. Here, we highlight a case of non-healing genital ulcers that did not respond to conventional antibiotic treatment and aggravated each month with menstruation. In this case, menstruation acted as a trigger factor for the development of a herpes genital infection. The latter acts as a pathergy for the monthly aggravation of genital PG. The patient responded to treatment with anti-viral medications and immunosuppressive medications.

Keywords: genital herpes; genital ulcers; herpes simplex virus; herpes simplex virus type 2 (hsv-2); pyoderma gangrenosum; unhealing ulcers.

Figure 1. Three well-defined shallow ulcers with violaceous margins and granulation tissue at the base, one on the mons pubis and two on the vulva.

Figure 2. Histopathology shows a dense perivascular neutrophilic infiltrate (hematoxylin and eosin, 40x).

Figure 3. Resolving lesions after one month of treatment.