Supplementary Material for: Eyelid Ulcer in an Immunocompromised Patient

Introduction: Eyelid ulceration can result from malignancy, trauma, infection, or inflammation. Immunosuppressed patients, such as those on methotrexate (MTX) therapy, are at higher risk for opportunistic infections like Purpureocillium lilacinum and Epstein-Barr virus (EBV)-associated mucocutaneous ulcers (EBVMCU). We report a rare case of eyelid ulceration due to concurrent EBVMCU and P. lilacinum infection. Case Presentation: An 82-year-old female with rheumatoid arthritis on chronic MTX therapy presented with a 6-month history of an ulcerated left upper eyelid lesion. Cultures confirmed P. lilacinum, and histopathology revealed EBV-positive atypical B cells. The ulcer resolved after discontinuing MTX and treating with oral voriconazole. Conclusion: This case highlights the need to consider both fungal and viral infections in immunosuppressed patients with unusual eyelid lesions. Timely diagnosis and appropriate treatment led to a successful outcome in this patient.