Hidradenitis suppurativa does not usually involve the deeper tissue, because it travels along and is limited by the fascia in the involved sites. However, it can perforate, although rarely, the rectum, urethra, urinary bladder, and the peritoneum. In one of the 22 cases of hidradenitis suppurativa reported by Brunsting,5 a rectal fistula had de¬ veloped from this disease. Anderson and Dockerty2 reported that there were no anal fistulas in their 117 cases of "perianal" hidradenitis-which term they use loosely to include the frequently associated buttock, crural, and genital involvement and that one of these patients died of peritonitis secondary to a perianal infection. Not only can hidradenitis suppurativa masquerade clinically as multiple perineal urethral fistulas,7 but it can, although rarely, produce such lesions. Other complications of this disease are squamous cell carcinoma and local and systemic infections, with their potential clinical consequences. As seen in the above reported case, the severe, chronic suppurative infection caused anemia, hypoproteinemia, and amyloidosis. The resultant severe anemia and hypoproteinemia affected adversely the patient's capacity to handle his infection and to heal postoperatively. Renal disease developed not only as a result of an as¬ cending infection secondary to hidradenitis sup¬ purativa, but also as a result of amyloidosis, sec¬ ondary to the chronic suppurative process of the underlying disease.The more severe complications of this disease can be avoided or reduced by early and adequate antibiotic and surgical therapy. Summary A 37-year-old Negro man had an extensive "fol¬ licular occlusion triad"4 which was characterized by dissecting cellulitis of the scalp, acne conglo¬ bata, and hidradenitis suppurativa. He had severe perianal and perineal hidradenitis suppurativa, with the rare complications of fistulas to the rec¬ tum, urethra, urinary bladder, and peritoneum. His death as a result of hidradenitis suppurativa is very unusual.
