A67-year-old woman with a past medical history of interstitial lung disease,
status post bilateral lung transplant, presented with persistent painful
bilateral labial lesions, which first appeared three months post-transplant.
The lesions were biopsied and initially diagnosed as an abscess. Additional
lesions developed and cultures grew Escherichia coli; however, despite
treatment with multiple antibiotics and tapering of immunosuppressive agents,
the lesions never resolved. A subsequent pelvic exam revealed three to five
erythematous papules on bilateral labia measuring up to 4 mm in greatest
dimension without spontaneous drainage. The patient underwent complete excision
of all vulvar lesions and the specimens were received in surgical pathology.
Microscopicexamination revealed a nodular proliferation of sheets of histiocytes occupying
the dermis with admixed lymphocytes and neutrophils, underlying an unremarkable
epidermis. Numerous targetoid, basophilic Michaelis-Gutmann bodies were
conspicuously seen within the proliferation, highlighted by von Kossa and
periodic-acid Schiff stains. Special stains for infectious organisms were
negative. A diagnosis of malakoplakia of the vulva was made.
