A rare manifestation of cutaneous lymphoid hyperplasia with conjunctival involvement

Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma, is a benign lymphoid proliferation. Conjunctival manifestations of CLH are exceptionally rare and can closely mimic ocular adnexal lymphoma. We report the case of a 59-year-old woman with facial CLH lesions who presented with a salmon-patch lesion of the bulbar conjunctiva. Histopathology from an incisional biopsy demonstrated a dense, B-cell-rich lymphoid infiltrate with prominent reactive follicles. Immunohistochemistry and immunoglobulin (Ig) heavy and kappa polymerase chain reaction (PCR) studies confirmed polyclonality, favouring reactive lymphoid hyperplasia over conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma; a key differential diagnosis in such a presentation. This case of synchronous cutaneous and conjunctival lymphoid hyperplasia raises the possibility of a multifocal reactive process involving both the skin and the ocular adnexa. It highlights the importance of careful clinicopathological correlation, consideration of cutaneous disease and multidisciplinary collaboration to avoid misdiagnosis and to guide appropriate treatment.