A 45-year-old white woman presented with a 2-year history of a persistent warty lesion of the vulva accompanied by dysuria and recurrent infection of the urinary tract. She had been unsuccessfully treated with topical acyclovir.
Physical examination disclosed a painless, papillomatous nodule on the left labium minus and some infiltrative perianal papules and nodules (Figure 1). The patient had left inguinal lymphadenopathy. Her abdomen was tender to palpation. She was otherwise well. There was no hematuria. The results of the following laboratory parameters were within normal limits: complete blood cell count, serum electrolyte profile, serum calcium levels, liver function tests, urinalysis, and screening for immunodeficiency virus and syphilis. A biopsy specimen was obtained from the vulva (Figure 2).
Fraysse-Consigny S, Chosidow O, Becherel P, Datry A, Frances C. Vulvar Lesion in a 45-Year-Old Woman. Arch Dermatol. 2002;138(9):1245-1250. doi:10.1001/archderm.138.9.1245