A 44-year-old female developed confluent, dusky red, pruritic labial papule
s clinically suspected to be genital warts. She had a long-standing history
of Crohn's disease with vulvar fistulae. The papular eruption developed af
ter several bouts of cellulitis in a region of vulvar lymphedema. Shave bio
psy of a papule exhibited papillated epidermal hyperplasia overlying a derm
is with a 'Swiss-cheese' appearance secondary to lymphedema and superficial
ectatic thin-walled vascular spaces characteristic of lymphangiectasias. R
eview of published cases reveals that acquired lymphangiomas often affect t
he vulva compared to other cutaneous sites and can be associated with surge
ry, radiation therapy, infection (e.g., erysipelas, tuberculosis), Crohn's
disease, congenital dysplastic angiopathy and congenital lymphedema. Rather
than translucent vesicles ('frog spawn') typical of extragenital cutaneous
lymphangiomas, vulvar lymphangiomas often present as verrucous papules tha
t can be mistaken for genital warts. In this case, we believe that the comb
ination of vulvar Crohn's disease and recurrent cellulitis resulted in loca
l lymphatic destruction, lymphedema and ultimately symptomatic lymphangiect
asias that mimicked genital warts.