Isolated Bilateral Periocular Lupus Miliaris Disseminatus Faciei: A Clinicopathological Mimicker of Granulomatosis With Polyangiitis.
Hamad Almutlaq
✦ AI-curated · Sources linked
Case in brief
A healthy young adult man presented with symmetrical papules confined to both periocular regions. Eyelid biopsy showed suppurative necrotizing granulomatous inflammation, prompting concern for granulomatosis with polyangiitis and other systemic granulomatous disorders. Autoimmune, vasculitic, infectious, urinary, orbital, and thoracic evaluations were negative apart from mild inflammatory marker elevations. The combination of folliculocentric papules, perifollicular necrobiotic suppurative granulomas, no true vasculitis, and no evidence of infection or systemic disease supported isolated periocular lupus miliaris disseminatus faciei. After 1 month of extended-release oral minocycline, lesions markedly flattened and crusted inflammation nearly resolved, without reported or observed adverse effects.
What made this case unusual
The biopsy raised concern for granulomatosis with polyangiitis, but clinicopathological correlation and negative systemic evaluation supported isolated periocular lupus miliaris disseminatus faciei instead.
Diagnostic / clinical pearl
Necrotizing suppurative granulomas on eyelid biopsy do not alone establish vasculitis; correlate histology with lesion distribution, evidence of true vasculitis, infectious studies, and systemic evaluation.