Extraordinary Case ReportTwo Unusual Cases of Discoid Lupus Erythematosus Associated With Xanthomatized MacrophagesWeiss, Amy MD*; Kwon, Eun Ji MD†,‡; Kreidel, Marit MD§; Mann, Ranon MD¶; Cohen, Jason A. MD‡; Hui, Yiang MD¶,║; Jacobson, Mark I. MD¶,║Author Information *Rutgers University, New Jersey Medical School, Newark, NJ; †Division of Dermatology, Rutgers University, New Jersey Medical School, Newark, NJ; ‡Dermpath Diagnostics New York, Port Chester, NY; §Department of Dermatology, Kaiser Permanente, Orange County, CA; ¶Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY; and ║Department of Pathology, Albert Einstein College of Medicine, Bronx, NY. Correspondence: Eun Ji Kwon, MD, Dermpath Diagnostics New York, 100 Midland Avenue, Port Chester, NY 10573 (e-mail: firstname.lastname@example.org). The authors declare no conflicts of interest. The American Journal of Dermatopathology: February 2020 - Volume 42 - Issue 2 - p 129-132 doi: 10.1097/DAD.0000000000001510 Buy Metrics Abstract We present 2 patients with chronic discoid lupus erythematosus (LE) associated with xanthomatized macrophages on light microscopic findings. Skin biopsies revealed hyperkeratotic and atrophic epidermis, vacuolar degeneration of the dermal–epidermal junction, thickened basement membrane, follicular plugging, and perivascular and perifollicular lymphohistiocytic infiltrate. Notably, large collections of lipid-laden histiocytes were observed within the subjacent dermis. The patients denied history of intralesional steroid treatment. The patients did not demonstrate any clinical or laboratory signs of hyperlipidemia, cholestasis, and diabetes mellitus and insipidus. Accumulation of lipid-laden foam cells in cutaneous LE is a rare phenomenon that has been reported in discoid LE and lupus panniculitis, each only once in the literature. It has also been described within lesions of various other dermatoses in patients without lipid, hepatic, or endocrine abnormalities. Its mechanism remains unclear, but it has been hypothesized that intracellular lipids released from degenerating cells contribute to lipidization of mononuclear scavengers. Xanthomatous infiltration in cutaneous LE is an unusual feature, and its presence may not necessarily signify an underlying metabolic disorder. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.