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Hidradenitis suppurativa: nidus for scrofuloderma.

CASE REPORT: 29 year old male came to our hospital for chronic discharge in his axillae and perineal region for 2 yrs. He was treated in various hospitals for similar complaints but there was no response. His younger brother also had similar complaints. (5,6) Clinical examination revealed multiple oozing plaques on axillae, groin, perineal region and multiple puckered scars. Investigations showed increased ESR, FNAC of lymph node showed AFB. PCR of lymph node was positive. Skin biopsy showed epithelioid cells, lymphocytes, langhan's cells, caseation and inflammatory reaction. The above findings confirmed the diagnosis of scrofuloderma in an existing Hidradenitis suppurativa condition. Patient treated with Antitubercular drugs (CAT-3) and follow up done. (7) The response was excellent.

DISCUSSION: Hidradenitis suppurativa is a chronic relapsing inflammatory disease originating in apocrine gland follicles which become chronic and indolent with induration, scarring of skin appendages and sinus formation. It is familial--Autosomal dominant, HLA A1 & B8 associated. (1,2) It occurs in axilla and perineal region characterized by painful, small, firm, subcutaneous nodules, indurated plaques and polyporous comedones. (3)

Scrofuloderma is a form of secondary cutaneous tuberculosis resulting from extension of underlying tuberculous focus such as lymph node, bone, joint, lacrimal gland even epididymis to overlying skin. It is characterized by bluish red nodules overlying infected gland or joint which breaks to form undermined ulceration with granulation tissue at the base. (8) Numerous sinuses and fistulae may communicate beneath ridges of bluish skin. On progression, it heals with puckered scars.

CONCLUSION: In places like India, oozing lesions resisted to treatment, cutaneous tuberculosis should be suspected. This case of hidradenitis suppurativa among brothers acting as nidus for scrofuloderma is quite rare. So it must always be borne in mind. Prompt diagnosis may favor treatment.

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DOI: 10.14260/jemds/2014/2267

REFERENCES:

(1.) Usma Iftikhar, Muhammad Nadeem, Shahbaz Aman, Atif Hasnain Kazmi. Scrofuloderma: a common type of cutaneous tuberculosis. A case report Journal of Pakistan Association of Dermatologists 2011; 21: 61-65.

(2.) Alikhan A; Lynch PJ; Eisen DB. Hidradenitis suppurativa: a comprehensive review. By: Journal Of the American Academy of Dermatology [J Am Acad Dermatol] 2009 Apr; Vol. 60 (4), pp. 539-61; quiz 562-3.

(3.) Muller H; Eisendle K; Zelger B; Zangerle R. Bilateral Scrofuloderma of the Axilla Masquerading as Hidradenitis Suppurativa. Acta Dermato-Venereologica [Acta DermVenereol]; Vol. 88 (6), pp. 629-30;

(4.) Kaya Esengul, Guzel Aygul, Bakirta Mustafa. Bilateral Inguinal Scrofuloderma Case Mimicking Hidradenitis Suppurativa. Duzce Medical Journal. 2012, Vol. 14 Issue 3, p90-93.

(5.) Nunez-Gussman J, Starke J, Correa A et al. A report of cutaneous tuberculosis in siblings. Pediatr Dermatol 2003; 20: 404-407.

(6.) Madan V; Gupta U. A report of scrofuloderma in siblings. Journal Of The European Academy Of Dermatology And Venereology: JEADV [J Eur Acad Dermatol Venereo] 2006 Sep; Vol. 20 (8), pp. 1029-30;

(7.) Karabudak O; Dogan B; Harmanyeri Y. Long-lasting scrofuloderma of hands and foot. Acta Dermato- Venereologica [Acta Derm Venereol], 2007; Vol. 87 (1), pp. 91-2.

(8.) Hay, Roderick. Cutaneous infection with Mycobacterium tuberculosis: how has this altered with the changing epidemiology of tuberculosis? editorial review. J April 2005 - Volume 18 - Issue 2 p 93-95.

AUTHORS:

1. R. Indradevi

2. K. Manoharan

3. Amit Shivaji Kerure

4. S. Karthik Raja

5. N. Azeem Jaffer

PARTICULARS OF CONTRIBUTORS:

1. Assistant Professor, Department of Dermatology, Aaruapadai Veedu Medical College Hospital, Pondicherry.

2. Professor and HOD, Department of Dermatology, Madras Medical College, Chennai.

3. Senior Resident, Department of Dermatology, Aaruapadai Veedu Medical College Hospital, Pondicherry.

4. Senior Resident, Department of Dermatology, Aaruapadai Veedu Medical College Hospital, Pondicherry.

5. Junior Resident, Department of Dermatology, Aaruapadai Veedu Medical College Hospital, Pondicherry.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. R. Indradevi, Department of Dermatology, Aarupadai Veedu Medical College and Hospital, Cuddalore Road, Pondicherry. E-mail: drindradevi@rediffmail.com

Date of Submission: 27/02/2014.

Date of Peer Review: 28/02/2014.

Date of Acceptance: 07/03/2014.

Date of Publishing: 24/03/2014.
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Article Details
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Author:Indradevi, R.; Manoharan, K.; Kerure, Amit Shivaji; Raja, S. Karthik; Jaffer, N. Azeem
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Case overview
Geographic Code:9INDI
Date:Mar 24, 2014
Words:653
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