Rituximab causing deep ulcerative suppurative vaginitis/pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a rare cause of purulent vulvovaginal ulceration. Six recent cases of vulvovaginal pyoderma gangrenosum associated with rituximab are described. All cases were seen in the setting of rituximab used for the treatment of B cell non Hodgkin's lymphoma (NHL). Age range was 50-74; symptoms were present for 2-24 months and severe pain, heavy discharge and large, deep purulent ulcers extending into the vagina were seen. This article reviews previous reports of vulvovaginal pyoderma gangrenosum, discusses important differential diagnoses in this setting, and provides evidence supporting rituximab as the cause of pyoderma gangrenosum in this cohort.