Medication-Induced Lymphomatoid Granulomatosis Presenting as a Solitary Periocular Cutaneous Lesion

Lymphomatoid granulomatosis, a rare lymphoproliferative disorder, was previously defined by categorical pulmonary involvement with possible invasion into the skin, central nervous system, liver, and kidneys. However, recent reports have documented confirmed cases of lymphomatoid granulomatosis without lung involvement. Here, the authors describe a 70-year-old male with rheumatoid arthritis on methotrexate who presented with an ulcerating lesion on the right lower eyelid, initially suspicious for a basal cell carcinoma. Biopsy and immunohistochemical staining revealed grade 3 lymphomatoid granulomatosis. Further workup showed no systemic involvement. The patient's presentation was thought to be secondary to chronic immunosuppression with methotrexate. Upon withdrawal of the medication, the lesion regressed. To the authors' knowledge, this is the first case report of methotrexate-induced lymphomatoid granulomatosis presenting with a singular periocular cutaneous lesion.