An eschar and violaceous nodules as the presenting signs of lymphomatoid granulomatosis

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder associated with infection by Epstein-Barr virus (EBV). The lung is the most common site of involvement, but LYG may initially manifest in the skin. LYG has been associated with immune dysregulation. Treatment regimens are not well-defined, but clinical trials targeting EBV have been successful. We report a 31-year-old male with LYG who presented with cutaneous symptoms. The skin biopsy was devoid of B-cells and non-reactive for EBV. We present this case to emphasize the role of dermatologists in the diagnosis of LYG and to caution clinicians that cutaneous lesions may lack diagnostic evidence of EBV infection.