Kisule Abraham, Kak Vivek, Alamelumangapuram Chidamber, Robinson Ciji
Rheumatology, Henry Ford Health System, Jackson, USA.
Infectious Disease, Henry Ford Health System, Jackson, USA.
Cureus. 2023 Nov 29;15(11):e49637. doi: 10.7759/cureus.49637. eCollection 2023 Nov.
Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory disorder of the hair follicles that localizes to the intertriginous and anogenital regions of the body. Lesions are characterized by inflammatory nodules, subcutaneous abscesses, fibrosis, and sinus tracts. Crohn's disease (CD) is an idiopathic chronic inflammatory bowel disease that affects any part of the gastrointestinal tract. Multiple treatment options exist for CD, including monoclonal anti-tumor necrosis factor alpha (TNF-α) antibodies like adalimumab (Humira). Adalimumab is an anti-TNF agent that has been approved by the United States Food and Drug Administration (FDA) for the treatment of HS. A 35-year-old African American male with a history of fistulizing CD presented to the hospital for evaluation of severe pain and purulent drainage from open sores in his bilateral axillary regions, groin, buttocks, and face for four days. He was on adalimumab for two years, during which time he noted the development of Hurley stage III HS. The physical exam was remarkable for a cachectic, painful-appearing male, with multiple abscesses on his lower jaw extending to his upper neck draining thick serosanguinous fluid, with similar findings in his bilateral axillary regions, bilateral groin, and perianal regions. He was treated with intravenous antibiotics consisting of a fourth-generation cephalosporin and vancomycin. While the etiology of HS in this patient is inconclusive, the timing of its development closely aligns with the initiation of Humira and is not a manifestation of CD. Paradoxical adverse effects describe a phenomenon in which a medication can induce a condition that it classically can be used to treat. In this patient's case, it was HS.
化脓性汗腺炎（HS）是一种慢性、使人衰弱的毛囊炎症性疾病，好发于身体的间擦部位和肛门生殖器区域。病变的特征为炎性结节、皮下脓肿、纤维化和窦道。克罗恩病（CD）是一种特发性慢性炎症性肠病，可累及胃肠道的任何部位。CD有多种治疗选择，包括单克隆抗肿瘤坏死因子α（TNF-α）抗体，如阿达木单抗（修美乐）。阿达木单抗是一种抗TNF药物，已获美国食品药品监督管理局（FDA）批准用于治疗HS。一名35岁有肛瘘型CD病史的非裔美国男性因双侧腋窝、腹股沟、臀部及面部开放性溃疡出现剧痛和脓性分泌物4天入院评估。他使用阿达木单抗治疗两年，在此期间他注意到出现了Hurley III期HS。体格检查发现该男性消瘦、面容痛苦，下颌至颈部上方有多个脓肿，引流浓稠的浆液性血性液体，双侧腋窝、双侧腹股沟及肛周区域也有类似表现。他接受了由第四代头孢菌素和万古霉素组成的静脉抗生素治疗。虽然该患者HS的病因尚无定论，但其发病时间与开始使用修美乐密切相关，并非CD的表现。矛盾的不良反应描述的是一种药物可诱发其通常用于治疗的疾病的现象。在该患者中，这种疾病就是HS。
