Recurrent Periocular Nodules: Lymphomatoid Papulosis in an Uncommon Anatomic Site

Lymphomatoid papulosis (LyP) is a rare cutaneous lymphoproliferative disorder involving the dysregulation of CD30-positive T-cells that accumulate in the skin. The accumulation of CD30-positive T-cells leads to the development of papulonodular lesions, which typically follow a protracted course and often resolve spontaneously in a matter of days to weeks. This case report describes a 44-year-old male patient who initially presented to the dermatology office with recurrent nodules under the right eye. He was diagnosed with periocular dermatitis initially, but when his condition failed to improve with minocycline, he was subsequently diagnosed with papulopustular rosacea and impetigo. However, despite multiple treatment trials, he still experienced recurrent flares with nodules that would arise only under the right eye and subsequent pain, swelling, and inflammation, which subsided as the lesions resolved. Histopathology of one of the lesions revealed a CD30-positive atypical lymphoid infiltrate, consistent with a diagnosis of LyP. Due to its close resemblance to other lymphoproliferative diseases, a diagnosis of LyP requires characteristic histological findings and a compatible clinical presentation, as neither alone is sufficient for diagnosis. This case report highlights the importance of integrating both clinical presentation and histopathologic findings to establish a diagnosis of LyP, especially when it arises in an uncommon anatomic site. LyP typically follows a benign course, but all patients diagnosed with LyP should have regular visits with a hematologist/oncologist to monitor for potential progression to malignant lymphoma.