Case notes
A healthy 68-year-old woman who had had 3 viable offspring and who had undergone hysterectomy had a 3-year history of mild vaginal prolapse. The condition was not bothersome. After being diagnosed with temporal arteritis, her rheumatologist began treating her with oral prednisone, 100 mg daily. Within 1 month of corticosteroid initiation, she experienced complete vaginal-vault eversion. The vaginal wall quickly became ulcerated, and she was unable to ambulate because of terrible pain that was related to the massive prolapse. Two months later, she was severely debilitated and confined to a scooter. During this time period, she also experienced steroid-induced diabetes mellitus and osteopenia.
On examination, total eversion of the vaginal vault was noted. Deep ulcerations covered approximately 60% of the vagina and were more prominent along the dependent portions of the prolapse ( Figures 1 and 2 ) . The genital hiatus measured 3.9 in (10 cm); the vaginal length measured 4.3 in (11 cm). Placement of a size-8 Gellhorn pessary (3.5) failed. Subsequently, the patient was instructed to coat the vagina with estrogen cream and cover the medication with an occlusive dressing (plastic wrap) each night. Because the ulcerations were not infected, no oral or topical antibiotics were prescribed.
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