Hidradenitis Suppurativa Complicated by Actinomycosis and Viral Hepatitis C: A Case Report

Document Type : Case Report

Authors

1 Department of Dermatovenereology and Cosmetology of the Novosibirsk State Medical University of the Ministry of Health of Russia, Novosibirsk, Russia

2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

Abstract

Introduction. Inverse acne (IA) is a chronic inflammatory skin disease that is more common in women, especially during puberty and menopause. It is believed that the first link of the pathogenetic mechanism is hyperkeratinization of the follicular cavity, followed by follicular occlusion, followed by expansion and rupture, and the presence of bacterial agents in the focus leads to the development of a local inflammatory reaction. Many concomitant diseases and triggers have been identified, including bacterial flora, which can significantly complicate the course of IA, lead to the chronization of the disease and a poor response to therapy. Early diagnosis of IA leads to the timely appointment of treatment. The diagnosis of IA is based on clinical features, and depending on the stage of severity according to Hurley, it is very important to choose the appropriate treatment.
Case presentation. The authors present a clinical case of IA complicated by actinomycosis and viral hepatitis C.
Conclusion. Actinomycosis is currently a rare diagnosis, especially in developed countries. In clinical practice, the diagnosis of actinomycosis can be difficult due to the nonspecific clinical and pathological features of the pathogen, its inherent difficulties in in vitro cultivation and complex histological characteristics. However, given the growing number of immunocompromised patients worldwide (for example, HIV-infected or hepatitis C patients) and numerous reports of infection with actinomycetes in these conditions, actinomycosis should be considered as a possible opportunistic infection.

Keywords


  1.  Nguyen TV, Damiani G, Orenstein LA. Hidradenitis suppurativa: An update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol. 2021;35:50–61.
  2. Vazquez BG, Alikhan A, Weaver AL. Incidence of hidradenitis suppurativa and associated factors: A population-based study of Olmsted county, Minnesota. J Invest Dermatol. 2013;133:97–103.
  3. Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2009;23:985–98.
  4. Sartorius K, Emtestam L, Jemec G, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the
    role of tobacco smoking and obesity. Br J Dermatol. 2009;161:831–9.
  5. Marzano A, Genovese G, Casazza G, et al. Evidence for ‘Window of opportunity’in hidradenitis suppurativa treated with adalimumab: A retrospective, real-life multicentre cohort study. Br J Dermatol. 2021;184:133–40.
  6. Navrazhina K, Frew JW, Gilleaudeau P. Epithelialized tunnels are a source of inflammation in hidradenitis
    suppurativa. J Allergy Clin Immunol. 2021;147:2213–24.
  7. Theut Riis P, Ring HC, Themstrup L. The role of androgens and estrogens in hidradenitis suppurativa –A systematic
    review. Acta Dermatovenerol Croat. 2016;24:239–49.
  8. Boer J, Jemec GB. Mechanical stress and the development of pseudo-comedones and tunnels
    in Hidradenitis suppurativa/Acne inversa. Exp Dermatol. 2016;25:396–7.
  9. Sabat R, Chanwangpong A, Schneider-Burrus S et al. Increased prevalence of metabolic syndrome in patients with acne inversa. PloS One. 2012;7:e31810.
  10. Qian G, Liu T, Zhou C, Zhang Y. Naevus comedonicus syndrome complicated by hidradenitis suppurativa-like lesions responding to acitretin treatment. Acta Derm Venereol. 2015;95:992–3.
  11. Hobeish MM, Shustov DV, Sokolovsky EV. Suppurative hydradenitis: modern ideas about pathogenesis,
    therapy and successful experience of treatment with adalimumab. Vestnik Dermatologii i                          Venereologii (InRussian). 2017;(5):70–81.
  12. Guet-Revillet H, Coignard-Biehler H, Jais JP, et al. Bacterial pathogens associated with hidradenitis
    suppurativa, France. Emerg Infect Dis. 2014 Dec;20(12):1990-8.
  13. Mishinev SV, Karchalova AM, Stupak VV., Serpeninova NN. Actinomycotic granuloma simulating malignant
    neoplasm of the brain. Journal «Questions of Neurosurgery» named after N.N.                                                        Burdenko (In Russian). 2015;5:63-67.
  14. Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future
    Microbiol. 2015;10(4):613–628.
  15. Breton AL, Lamblin G, Pariset C, Jullien D. Cutaneous Actinomycosis associated with anti-TNF-alpha
    therapy: report of two cases. Dermatology. 2014;228(2):112–114.
  16. Khryanin AA, Markaryan DR, Garmanova TN, Bocharova VK. Dermatoses of the perianal area. Part 1. Klinicheskaya Dermatologiya i Venerologiya (In Russian). 2021;20(3):69-75.