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

BACKGROUND Lupus miliaris disseminatus faciei (LMDF) is a rare idiopathic granulomatous dermatosis that presents as discrete yellow-brown, erythematous, or skin-colored papules on the central face, with a recognized preference for the eyelids and periorbital region. CASE REPORT We report a case of isolated bilateral periocular LMDF in a healthy young adult man whose initial eyelid biopsy revealed suppurative necrotizing granulomatous inflammation, raising histopathological concern for granulomatosis with polyangiitis and other systemic granulomatous diseases. Autoimmune, vasculitic, infectious, urinary, orbital, and thoracic evaluations were otherwise negative, apart from only mild inflammatory marker elevation, with an erythrocyte sedimentation rate of 21 mm/h (reference range, 0-20 mm/h) and C-reactive protein level of 0.94 mg/dL (reference range, 0.1-0.5 mg/dL). The final diagnosis was supported by the clinicopathological combination of symmetrical folliculocentric periocular papules, perifollicular necrobiotic suppurative granulomas, absence of true vasculitis, negative infectious studies, and absence of systemic disease. After 1 month of extended-release oral minocycline, the patient had marked flattening of papules and near-complete resolution of crusted inflammatory lesions. Adverse effects were monitored clinically during routine follow-up after completion of the 1-month treatment course; the patient reported no treatment-related adverse effects, and no adverse effects were observed. CONCLUSIONS Clinicopathological correlation and comprehensive systemic evaluation are necessary to differentiate this rare dermatosis from infectious or vasculitic mimics. In this patient, oral minocycline was associated with marked short-term clinical improvement after 1 month, but this single observation does not establish broader therapeutic efficacy for LMDF.