REPORT OF A CASE
A 23-year-old black woman with a 7-year history of Crohn's disease presented to her internist complaining of vulvar itching and swelling. The labial swelling began as a single nodule that spread quickly to involve both labia over a 2-week period. Prior to this, she was not receiving medication and was doing well since undergoing a left hemicolectomy with colostomy in 1979. In 1984, she underwent a right colectomy with terminal ileum resection and ileostomy. She was placed on empiric therapy with ampicillin, metronidazole for 3 days, and nystatin orally with no improvement. The patient was admitted to the hospital for further examination.The physical examination on admission was remarkable for markedly swollen labia bilaterally (Fig 1). The perineum just below the labia was markedly indurated and erythematous. A few perifollicular pustules just below the labia were seen. No ulcerations or fistulas were found during the examination.