Purpose of Study Hidradenitis Suppurativa (HS) is a chronic disorder involving apocrine glands characterized by comedo like follicular occlusion and a chronic relapsing inflammation; sinus tracts and scarring. We observed a case of HS in a young African American (AA) male with relapsing polyarthritis.
Methods Used The patient first developed HS as a teenager and then arthritis 10 years later. On this presentation he had multiple nodular skin lesions, predominately in intertriginous areas in the axilla and inguinal area; few of them presenting as draining pustules which had increased in size and number as well as generalized arthritis. This occurs 1–2 times yearly subsiding in association with antibiotic treatment. Physical examination was notable for generalized suppurate nodules chronic scars and sinuses. Joint examination revealed generalized polyarthritis with effusions in ankles, knees and elbows. Laboratory evaluation revealed marked inflammation. Autoantibody studies were negative. Radiographs revealed demineralization, erosions including the distal interphalangeal joints with suggestion of pencil/cup deformity in an asymmetric manner. All cultures were negative. Urine Chlamydia and Neisseria polymerase chain reaction testing was also negative.
Summary of Results Musculoskeletal association with HS has been reported. Most note an association of skin flares and that it tends to occur years after the onset of skin disease. Most reports are anecdotal. We identified one multicenter analysis. The pattern of disease described resembles the spondyloarthropathy manifestations including sacroiliitis, dactylitis, inflammatory back pain and entesthitis. Our patient's findings were consistent with the limited literature available.
Conclusions In conclusion, we propose that inflammatory spondyloarthropathy may be a complication of HS.
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