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Lymphomatoid granulomatosis initially presenting as ulcerated subcutaneous and muscle lesions without pulmonary involvement

Dear Editor, Lymphomatoid granulomatosis (LYG) is an angiocentric and angiodestructive lymphoproliferative disorder. It is comprised of Epstein–Barr virus (EBV)-positive B cells admixed with reactive T cells that tend to predominate. While LYG most commonly affects the lung, it can involve multiple extranodal sites. We report a patient who developed LYG after methotrexate (MTX) therapy for rheumatoid arthritis (RA). A 79-year-old man presented with an ulcerated subcutaneous induration in the left lumbar region that had appeared 10 months earlier (Fig. 1a). His RA had been treated with MTX for 9 years.