Ulcerative Necrobiosis Lipoidica in the Setting of Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma and Glucose-6-Phosphate Dehydrogenase Deficiency

Necrobiosis lipoidica (NL) is a chronic granulomatous disease most commonly manifesting as yellow, atrophic plaques and ulcerations on the lower extremities. We present an exacerbation of NL in a patient with a known history of glucose-6-phosphate dehydrogenase deficiency, who, following a clinical and histopathologic diagnosis of NL, was found to have oropharyngeal Epstein-Barr virus-positive diffuse large B-cell lymphoma. After implementation of therapies for lymphoma, chemotherapeutic complications, and NL, the patient reported improvement in both pain and ulcerations. Though noninfectious granulomatous reactions are common in lymphoproliferative disorders, the skin is rarely involved. This case presentation provides evidence for an association between NL and underlying lymphoma development and encourages clinicians to rule out lymphomatous processes in the setting of reoccurring or recalcitrant noninfectious cutaneous granulomas.