A Classic Clinical Case: Neutrophilic Eccrine Hidradenitis

Abstract

Background: Neutrophilic eccrine hidradenitis (NEH) is a rare condition described mostly in adult patients receiving chemotherapy for acute myelogenous leukemia. When it affects the facial region, it can mimic cellulitis and delay the diagnostic, thus proper recognition is essential. Objective: This article describes a classic case of NEH. We will review the diagnostic, the differential diagnostic (mostly cellulitis) and the management of this condition. Methods: After a literature review, the patient's file was properly studied in order to portray a clear picture of this condition. Medical photographs and appropriate physical examination upon presentation are also included. Results: The diagnostic for NEH was suggested by the clinical presentation and confirmed histopathologically (skin biopsy). Conclusion: The diagnostic of NEH is essential in order to prevent multiple unnecessary antibiotics.

Neutrophilic eccrine hidradenitis secondary to pegfilgrastim in a patient with synovial sarcoma

“…Only a few cases of NEH have been previously reported in the pediatric population. NEH may clinically appear similar to infection and therefore must be distinguished by blood cultures and skin biopsy to guide appropriate therapy . Extracutaneous involvement, although seen in Sweet Syndrome, has not been previously reported in NEH .…”

“…Neutrophilic eccrine hidradenitis is a rare neutrophilic dermatosis characterized by the development of tender, edematous, erythematous papules and plaques . Histologic examination shows neutrophilic infiltration of the eccrine unit and necrosis of the eccrine coils and glands . It has been associated with malignancies such as acute myelogenous leukemia (AML), Wilms’ tumor, testicular carcinoma, osteosarcoma, Hodgkin's disease, and Non‐Hodgkin's lymphoma .…”

“…Patients classically present with tender, erythematous and edematous papules and plaques and rarely, with purpuric lesions . Sites of involvement include the upper trunk, upper limbs, face (especially the periorbital area), palms, and soles . The axillae and inguinal folds are classically spared.…”

“…Neutrophilic eccrine hidradenitis can mimic cellulitis, and therefore, infection should be ruled out. The diagnosis is histologic, requiring a punch biopsy . The primary histologic feature is neutrophilic infiltrate in and around the eccrine glands .…”

“…In neutrophilic eccrine hidradenitis (NEH), the neutrophilic infiltrate has a special predilection for the eccrine glands . Due to association with fever and similar clinical appearance to cellulitis, the diagnosis of NEH requires a skin biopsy . Additionally, infectious workup should be performed to rule out infectious etiology because the treatment would be different .…”