Subperiosteal deep granuloma annulare of the orbital rim

FIGURE 3: Histologic findings A 52-year-old Caucasian male with rheumatoid arthritis presented with a five-week history of a 1 cm left upper lid central mass. He denied antecedent trauma, insect bites, recent viral illness, or other skin lesions or changes. He had no recent fevers, chills, weight loss, or night sweats. His past medical history was significant only for hypertension and rheumatoid arthritis, with a positive Rheumatoid factor and anti-CCP antibodies. His medications included methotrexate, sulfasalazine, intermittent Prednisone, and folate. On exam the mass was non-tender and appeared fixed to the lateral aspect of the left superior orbital rim. There was an additional flesh-colored plaque involving the skin overlying the medial aspect of the superior lid consistent with a xanthoma. He had no associated diplopia, vision changes, or ocular discharge. There was no change in his lid closure.