A Life-Threatening Multilocalized Hidradenitis Suppurativa Case

Oktay Buyukasik, MD; C. Gokhan Osmanoglu, MD; Yilmaz Polat, MD; Hulagu Kargici, MD; Gulay Kaya, MD


October 20, 2005


The incidence, prevalence, and etiology of HS are not known. However, it is believed not to be rare.[4,10] In an important portion of cases, there are small lesions that can be tolerated by the patient because they are not frequently active. Many patients can be misdiagnosed as having pilonidal sinus, folliculitis, or furuncle. For this reason, the disease can be widespread for many years and may lead to serious physical and social morbidity. The pain, restriction of movement, anemia, abscess flow, and smell caused by the infection may put an end to the social and professional life of the patient.

After the lesions at the axilla are deeply excised with both broad and partial lymphatic dissection, the wide graft that emerges should absolutely be covered by a flap to avoid restriction of movement. Different methods are defined.[10,11,12] The method we used is a parascapular fasciocutaneous flap. On the other hand, a small triangular defect on the scapula is covered with a skin graft. The results are perfect. No restriction of movement is encountered (Figures 12 and 13).

The appearance of the gluteal region at the end of the operative procedure.

In the follow-up period there is no restriction of movement.

The characteristics of the lesions at the hip change according to the chronic pressure; while they should be limited to the fascia, they also affect the gluteal muscles, and they even reach up to the retrococcygeal area and cause the formation of rectal fistulas. Therefore, we think the lesions in this area should be excised widely because the lesions in this location are much larger prior to such complications. More importantly, the lesions at this area should be diagnosed earlier, we think early surgical intervention should be performed. Such an attitude will facilitate the surgical treatment as well. In the magnetic resonance images of the hip lesion of our patient taken 6 years previously, the diameter of the lesion was about one fifth of the size of the lesion when we operated. Treatment will get even more difficult as a result of the growth of the fistulas.

The lesions at the scrotum and perineum should be treated surgically because the lesions in this area are more painful, cause movement restriction, and carry the risk of urethral fistula. After total excision, the defect must be covered by a skin graft. The HS lesions in other sites may sometimes be treated medically.

The coexistence of HS with diseases, such as Crohn's disease, irritable bowel syndrome, Down syndrome, Grave-Hashimoto thyroiditis, arthritis, Sjögren's syndrome, and herpes simplex, is more frequent than that in the normal population.[13,14,15] We detected hypospadias in our patient and at the end of the treatment, Hodgkin's lymphoma was diagnosed. We could not find any coexistence of hypospadias and HS in the literature. And, to our knowledge, there is no information in literature about the relationship between HS and Hodgkin's lymphoma.


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