Ectopic Hidradenitis Suppurativa: Case Report and Review of
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Hidradenitis suppurativa is a follicular-based inflammatory disease defined by its chronicity, recurrence, and severe pain.

A 59-year-old Caucasian man with a past medical history of thyroid cancer that was treated with radioactive ablation subsequently maintained on levothyroxine and hypertension presented with a painful, enlarging lesion on his right posterior thigh. The lesion initially appeared as a papule that progressed to a pustule from which purulent fluid could be expressed. He also had a prior history of methicillin-susceptible Staphylococcus aureus (MSSA) infection that resolved after treatment with oral cephalexin.

Physical examination revealed a 4.0 × 3.5-cm tender, erythematous nodular plaque with peripheral scale on the right posterior thigh. The clinical differential diagnosis, based on the morphology of his lesion, included furuncle, carbuncle, abscess, and suppurative cellulitis. A bacterial culture of the purulent drainage was collected and treatment with oral cephalexin 500 mg four times a day and topical mupirocin 2% ointment was initiated.

Microscopic examination of the tissue biopsy revealed suppurative inflammation with mixed inflammatory infiltrates.

Apocrinitis was not observed; we speculate that this was due to the destruction of adnexal structures by the inflammatory process. Subsequently, the results of the tissue cultures for infectious pathogens were negative. Correlation of clinical and pathologic examination established the diagnosis of ectopic hidradenitis suppurativa.

The patient received 2 mL of 10 mg/mL of intralesional triamcinolone and was started on oral doxycycline monohydrate 100 mg twice daily, chlorohexidine gluconate washes daily, and topical 1% clindamycin solution twice daily. Due to the novel coronavirus 2019 pandemic and clinic closure, the patient was not seen for six months.

At the time of follow-up, drainage had subsided and h associated pain had resolved. In addition, the lesion had decreased in size; however, residual sinus tracts persisted. The patient was content with the clinical improvement and did not want any additional treatment.