Presenter: Michael Lipp, D.O. Nady Hin, D.O., Rachel White,D.O.

Dermatology Program: LECOMT/Larkin Community Hospital Palm Springs Campus

Program Director: Brad Glick, D.O., MPH

Submitted on: April 20, 2017

CHIEF COMPLAINT:  Inflammatory nodules/abscesses and joint pain

CLINICAL HISTORY: Twenty-year-old male presents with history of multiple painful inflamed nodules, abscesses and draining sinus tracts involving the face, chest, axilla, groin, and back for which was diagnosed as Hidradenitis Suppurativa (HS). Patient reports surgical history of multiple sinus tract excisions. Past medical history includes scarring acne of the face, chest, and back, pilonidal cyst that was surgically removed, and Crohn’s disease. Upon further questioning, it was learned that the patient was worked up at the hospital for back pain years prior. During that hospital stay an MRI revealed sacroiliitis and patient has been subsequently following up with a Rheumatologist.

Review of systems: (+) depression, anxiety, joint pains, back pain

Previous Treatment:  Isotretinoin, dapsone (oral), doxycycline (oral), sulfamethoxazole/trimethoprim (oral), clindamycin (topical), mupirocin (topical), infliximab (Remicade) for Crohn’s

PHYSICAL EXAM:
Multiple painful inflamed nodules/papules involving the face, neck, chest and back. Post surgical scars from history of draining sinus tracts involving groins. Large central scar involving the sternal region of the chest.

LABORATORY TESTS:

1. ESR, CRP WNL
2. WBC: 8.2, HgB: 12.3, Hct: 38.5, RDW: 17.3, MCH: 23.6, MCV: 73.9
3. Negative cultures of pustular nodules

DIFFERENTIAL DIAGNOSIS:

1.   SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) Syndrome
2.   Concomitant Crohn’s and HS
3.   Acne Conglobata
4.   Acne Fulminans
5.   CRMO (Chronic Recurrent Multifocal Osteomyelitis)