Pyoderma Gangrenosum Presenting As Recurrent Vulvar Ulceration in a Nine-Year-Old Girl: A Case Report.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by rapidly progressive, painful ulcerations that often mimic infectious processes. Vulvar involvement is an uncommon presentation, particularly in pediatric patients, making the diagnosis especially challenging. We report the case of a nine-year-old girl who presented with rapidly evolving vulvar ulcerations that were unresponsive to intravenous and topical antibiotics. Because of the unusual clinical presentation and lack of response to antimicrobial treatment, a skin biopsy was performed, revealing dense neutrophilic dermatitis consistent with PG. An extensive evaluation failed to identify any associated systemic disease. After initiation of corticosteroid therapy, the patient showed marked clinical improvement, supporting the diagnosis of PG. This case describes an atypical pediatric presentation of vulvar PG and highlights the importance of considering PG in the differential diagnosis of persistent vulvar ulcerations. Early recognition may prevent unnecessary antimicrobial exposure, reduce diagnostic delays, and allow prompt initiation of appropriate immunosuppressive therapy.