Plasminogen deficiency as a rare cause of conjunctivitis and lymphadenopathy

Plasminogen deficiency is a rare disorder complicated by the subsequent formation of firm "woody" plaques in the eye (ligneous conjunctivitis) or other mucosal sites as the result of inflammation or trauma. The plaques are composed of fibrinogen, granulation tissue, and inflammatory cells. The findings may be considered nonspecific by the unsuspecting surgical pathologist and delay the appropriate diagnosis. We report the first case of lymph node involvement with characteristic eosinophilic hyaline deposits that are periodic acid Schiff positive, stain dark red with Masson trichrome, and contain fibrinogen as detected by immunofluorescence and describe the longitudinal evolution of this patient's disease over a 15-year period. The differential diagnosis of amorphous hyaline material in lymph node biopsies is discussed.