Neutrophilic Eccrine Hidradenitis in an Hiv‐infected Patient

Abstract

A 30-year-old man who is an intravenous drug addict (not known to be Hiv-positive) was admitted to hospital complaining of fever and general malaise. The last dose of heroin had been administered 4 days previously and he had been taking dextropropoxyphenone since then. On admission, the leukocyte count was 9,200 per mL (neutrophils 8,100, lymphocytes 250), hemoglobin 12.4 g per dL, and the platelet count was 183,000 per mL. After a radiologic diagnosis of pneumonia was made, cloxacillin (1 g every 8 h iv) and gentamicin (80 mg every 8 h iv) were started, together with fluconazole (100 mg per day orally) for oropharyngeal candidiasis. Methadone, lorazepam, and flunitrazepam were given to prevent an opiate withdrawal syndrome. Seven days after admission, 12 erythematous maculae, of 5 mm diameter, were seen on the anterior thorax, together with pancytopenia (leukocyte count 700 per mL, neutrophils 600 per mL, lymphocytes 0 per mL, hemoglobin 10.9 g per dL, platelets 16,000 per mL) and persistent fever. Two days later, the patient died of acute respiratory insufficiency. Pneumocystis carinii and acid/alcohol-resistant bacilli were later confirmed by stain and culture, in the sputum, as was the positive HIV serology. A skin biopsy specimen showed a neutrophilic inflammatory infiltrate, together with necrosis of the epithelial cells of the eccrine coils (Fig. 1). The epidermis and the eccrine ducts in the dermis were intact. Neither mucin deposits nor squamous metaplasia of the eccrine ductal epithelium were seen. Special staining for bacteria, fungi, and acid-fast bacilli was negative.

Chronic pruritic neutrophilic eccrine hidradenitis in a patient with Behcet's disease

“…Other associations were later recognized, in addition to chemotherapeutic drugs, including infectious diseases (HIV and Serratia marcescens ), drugs (granulocyte colony‐stimulating factor and acetaminophen), and haemodialysis; NEH has also been reported in a healthy patient 5,8–14 . Our patient did not have an underlying malignancy, she was not exposed to chemotherapeutic drugs, and her HIV serology was negative.…”

Diseases of cutaneous appendages

“…1538 It has been reported in patients with leukemia, unassociated with chemotherapy. 1541 It has also been reported in HIV-infected patients, [1542][1543][1544] and also in Behçet's disease. 1541 It has also been reported in HIV-infected patients, [1542][1543][1544] and also in Behçet's disease.…”

Neutrophilic Dermatoses in Children

“…Fever and arthritis are common. Classical NEH may be associated with malignancy (acute myelogenous leukemia), lupus (78), Behçet disease (BD) (79), and infections (HIV, serratia, nocardia, and Staphylococcus ) (80–83). Neutrophilic eccrine hidradenitis often occurs during chemotherapy, possibly because of direct chemotherapy toxicity to eccrine glands (66,67).…”