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

## TL;DR

A patient with a skin condition called necrobiosis lipoidica also had lymphoma and a genetic deficiency, suggesting a possible link between the skin disease and cancer.

## Contribution

This case suggests a possible association between necrobiosis lipoidica and underlying lymphoma.

## Key findings

- The patient had NL, G6PD deficiency, and EBV-positive lymphoma simultaneously.
- Treatment for lymphoma improved both the lymphoma and NL symptoms.
- NL may be a sign of underlying lymphoma and should prompt further investigation.

## Abstract

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.