Case report: Unusual complications of severe hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS, from the Greek hidros = sweat, and aden = glands) is a chronic inflammatory skin condition that is also known as acne inversa (AI). [1] HS/AI is a chronic follicular occlusive disease involving the follicular portion of folliculopilosebaceous units (FPSUs). [1] The prevalence of HS/AI has varied, ranging from less than 1% to 4%. [2] The onset of symptoms typically occurs between puberty and age 40, most commonly in the second or third decade of life. [2] The incidence of HS/AI is twice as high among women than men. [2] Genetic susceptibility, mechanical stresses on the skin, obesity, smoking, diet and hormonal imbalances are repeatedly cited as factors that may be associated with the development or exacerbation of HS/AI. [3] The primary sites of involvement for HS/AI are the intertriginous skin areas of the axillary (61%), groin (48%), perianal (30-50%), perineal (22%) and inframammary regions (13%), though it can occur in any skin area that contains FPSUs. [2] The clinical manifestations vary, ranging from recurrent inflamed nodules and abscesses to draining sinus tracts and bands of severe scar formation. [3] The associated pain, malodour, drainage and disfigurement that accompany HS/AI contribute to its profound psychosocial impact on many patients. [3] Case report An 18-year-old female was diagnosed with bilateral axillary HS in 2014. She was a known smoker, with a body mass index of 21, and no known medical comorbidities. Clinical findings She presented in 2017 with advanced Hurley stage III disease, with extensive painful open wounds extending from both axillae onto the chest wall and upper arms, and threatening to erode the left brachial vessels (Fig.1). The patient also had severe bilateral shoulder adduction contractures and reduced function, with oedema of the left arm. The perineum, perianal and groin regions were not involved. Laboratory investigations Laboratory tests showed: white cell count of 27.25 × 109/L with predominant neutrophils; haemoglobin 7.8 g/dL; haematocrit 15%; platelet