Granulomatous vulvitis complicated by polymicrobial growth

Granulomatous vulvitis (GV) is a rare chronic inflammatory condition presenting with persistent vulvar swelling and noncaseating granulomas, often mimicking Crohn's disease and sarcoidosis. We report a 21-year-old sexually inactive woman with a five-month history of painless vulvar swelling and occasional itching, complicated by secondary polymicrobial infection. A thorough evaluation excluded other granulomatous diseases, and histopathology revealed noncaseating granulomas, supporting the diagnosis of granulomatous vulvitis. Initial antibiotic therapy was followed by hydroxychloroquine, and intralesional triamcinolone, leading to marked symptom resolution. This case highlights intralesional corticosteroids as an effective first-line treatment and underscores the need for a multidisciplinary and personalized approach in managing GV, particularly in the presence of secondary infections.