Lymphomatoid granulomatosis in an octogenarian patient: a case report

Introduction: Lymphomatoid granulomatosis (LG) is a rare lymphoproliferative and angiodestructive disorder caused by the Epstein-Barr virus (EBV). It is usually observed between the fourth and sixth decade of life, affecting males more frequently, and is histologically classified depending on the number of EBV-positive large B cells. Case presentation: In February 2023, an 81-year-old man presented to the dermatology department of a tertiary care hospital in Bogotá D.C. (Colombia) due to a 5x3cm ulcerative lesion with a dirty background and erythematous, violaceous, indurated borders with hematic crusts on the left hypochondrium that appeared 10 months earlier. The patient underwent multiple histopathological studies that were inconclusive, so in April 2023 he was referred to the dermatology service of a quaternary care hospital, where, based on the results of complementary studies (immunohistochemistry) and anti-neutrophil cytoplasmic antibody test in peripheral blood and EBER-ISH test, he was diagnosed with grade 3 LG in June 2023. Consequently, he started treatment with immunochemotherapy (R-mini-CHOP scheme; 6 cycles; 1 every 21 days), achieving complete remission of the disease. Conclusion: Although LG is a rare condition that usually occurs between the fourth and sixth decade of life with a predominant initial clinical manifestation of pulmonary involvement, it should be suspected in patients with refractory skin lesions, regardless of their age since, in some cases, they may precede pulmonary lesions. Relevant histopathological studies should therefore be performed.