“…6,7,11,13,15,17,19,20 In addition, spongiosis, hyperkeratosis, dying keratinocytes, vacuolization at the dermoepidermal junction, and tuberculoid granulomas can also be seen on the histologic sections. 7,[10][11][12]17 These findings can present at the time of HLH onset, yet preceding isolated skin lesions are rarely reported. 7,10 Similar to our case, Brinkmeier et al 7 reported Ebstein-Barr-Virus-associated HLH that initially presented with hyperkeratotic granulomatous nodules.…”