Change in the homeostasis of a healthy vaginal microbiome and precipitating factors leading to the overgrowth of virulent bacteria/fungus are common causes of vulvovaginitis. The vaginal flora balance is still being studied as is the use of repopulation of depleted healthy flora using bacterial cultures. We describe a case of a 40-year patient with systemic lupus erythematous on daily prednisone and hydroxychloroquine with a history of recurrent vulvovaginitis, who received multiple rounds of antibiotics, and eventually presented with culture confirmed Pseudomonas aeruginosa vaginitis.