LAUSR

CASE REPORT A 66-year-old white man with a history of ulcerative colitis in remission for 5 years after infliximab treatment presented complaining of a pruritic and painful red rash over his face for greater than a year. Examination found erythematous edematous granulomatous papules and plaques (Fig 1). Histopathology testing found a dense nodular infiltrate of small and large lymphocytes, histiocytes, plasma cells, and eosinophils. Immunohistochemistry findings showed that the small, CD3 lymphocytes exhibited a normal CD4:CD8 ratio. The large lymphocytes were CD20. The plasma cells were of polyclonal lineage, expressing both k or l light chains. The diagnosis of CLH was made. Complete blood count and comprehensive metabolic panel were unremarkable. Viral hepatitis and HIVresults were negative. Computed tomography of the chest, abdomen, and pelvis and a hematology/ oncology workup were normal. The CLH proved refractory to treatment with incomplete responses to clobetasol, intralesional triamcinolone, hydroxychloroquine, mycophenolate mofetil, doxycycline,