Acquired vulvar lymphangioma mimicking genital warts. A case report and review of the literature

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.