Severe hidradenitis suppurativa treated with infliximab infusion.

A 17-year-old male patient with a 3-year history of hidradenitis suppurativa presented to our dermatology clinic for more effective treatment. Areas of involvement included the medial aspect of the thighs, scrotum, buttocks, and inframammary folds. His axillae were spared. He also had a pilonidal cyst and nodulocystic acne. A diagnosis of hidradenitis suppurativa was rendered. The patient’s symptoms included groin and perineal pain, serous and purulent discharge, and malodor. His primary care physician had been treating him with prednisone (5 mg twice a day) for more than 2 years and cephalexin (500 mg twice a day) for 2 weeks. He also had ulcerative colitis, which had been diagnosed 4 months earlier, that was controlled with sulfasalazine (1g three timesaday)andazathioprine (50mg/d). He took supplemental iron and folic acid (1 mg/d) for anemia. Figure 1A shows his groin at the initial visit. The prednisone therapy had caused significant adverse effects, including a cushingoid appearance, obesity (weight, 80.4 kg), striae, gynecomastia, and diabetes mellitus, which had presented as diabetic ketoacidosis 4 months before he was seen in our dermatology office. At that time, his diabetes was treated with insulin and rosiglitazone maleate (4 mg twice a day). Six weeks later, his insulin therapy was discontinued, and metformin hydrochloride therapy (500 mg/d) was initiated. He also took potassium, magnesium, and calcium supplements.