Isolated Bilateral Periocular Lupus Miliaris Disseminatus Faciei: A Clinicopathological Mimicker of Granulomatosis With Polyangiitis.

A healthy young adult man presented with isolated bilateral periocular lupus miliaris disseminatus faciei (LMDF), a rare idiopathic granulomatous dermatosis.

• LMDF presents as discrete yellow-brown, erythematous, or skin-colored papules on the central face, with a recognized preference for the eyelids and periorbital region.
• The patient's lesions were symmetrical, folliculocentric periocular papules.
• This is a single case report.

The initial eyelid biopsy showed suppurative necrotizing granulomatous inflammation, which raised histopathological concern for granulomatosis with polyangiitis and other systemic granulomatous diseases.

• The final diagnosis was supported by perifollicular necrobiotic suppurative granulomas.
• There was no true vasculitis on histology.
• The histology mimicked granulomatosis with polyangiitis, so the case is framed as a clinicopathological mimicker.

Systemic workup for autoimmune, vasculitic, infectious, urinary, orbital, and thoracic disease was negative apart from mild inflammatory marker elevation.

• Erythrocyte sedimentation rate was 21 mm/h (reference range, 0-20 mm/h).
• C-reactive protein was 0.94 mg/dL (reference range, 0.1-0.5 mg/dL).
• Infectious studies were negative and there was no systemic disease.

The diagnosis of LMDF rested on the combination of clinical and pathological features together with exclusion of mimics.

• The supporting features were symmetrical folliculocentric periocular papules, perifollicular necrobiotic suppurative granulomas, absence of true vasculitis, negative infectious studies, and absence of systemic disease.
• The author concludes that clinicopathological correlation and comprehensive systemic evaluation are necessary to differentiate LMDF from infectious or vasculitic mimics.

One month of extended-release oral minocycline was associated with marked clinical improvement.

• Papules showed marked flattening.
• Crusted inflammatory lesions showed near-complete resolution.
• The patient reported no treatment-related adverse effects, and none were observed during routine follow-up after the 1-month course.

The author cautions that the single-patient response to minocycline does not establish broader therapeutic efficacy for LMDF.

• Improvement was assessed only as short-term, after 1 month.
• The report describes one patient with no control comparison.