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CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 411-413
A Case of Neutrophilic Eccrine Hidradenitis in a Patient with Crohn's Disease


1 Department of Dermatology and Venereology, Near East University, Faculty of Medicine, Nicosia, Cyprus
2 Department of Pathology, Near East University, Faculty of Medicine, Nicosia, Cyprus

Date of Web Publication17-Sep-2021

Correspondence Address:
Serap Maden
Department of Dermatology and Venereology, Near East University, Faculty of Medicine, Nicosia
Cyprus
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_92_18

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How to cite this article:
Maden S, Mullaaziz D, Özkayalar H. A Case of Neutrophilic Eccrine Hidradenitis in a Patient with Crohn's Disease. Indian J Dermatol 2021;66:411-3

How to cite this URL:
Maden S, Mullaaziz D, Özkayalar H. A Case of Neutrophilic Eccrine Hidradenitis in a Patient with Crohn's Disease. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 2];66:411-3. Available from: https://www.e-ijd.org/text.asp?2021/66/4/411/326148




Sir,

Neutrophilic eccrine hidradenitis (NEH) is a rare skin disease in neutrophilic dermatoses (NDs) group characterized by the presence of cutaneous aseptic infiltrate of polymorphonuclear neutrophils around eccrine coils and glands. The clinic presentation of NEH generally appears with asymptomatic erythematous papules, plaques, or small nodules involves the face, upper extremities, palms, and soles.[1],[2] NEH is mostly associated with haematological malignancies and frequently seen in patients with acute myelogenous leukemia receiving chemotherapy.[3]

A 24-year-old female patient referred to our outpatient clinic for asymptomatic red papules and pustules on the upper body. Lesions initially started on the neck three months ago and then spread to the trunk and arms within one-month period without pruritus, pain, or burning sensation. Before consulting to our clinical examination, the patient had used topical steroids and topical antibiotics via doctor advice however there had been no progress. Two months before the onset of skin lesions, she was undergoing azathioprine (AZA) treatment because of Crohn's disease. She had no fever or arthralgia since the eruption started. Dermatological examination revealed smooth surfaced, slightly infiltrated, erythematous, oedematous papules, and pustules on her neck and the upper body with the extensor areas of bilateral arms [Figure 1]a and [Figure 1]b. At the time she visited our policlinic to check her complete blood count, C-reactive protein, erythrocyte sedimentation rate, liver enzymes, blood urea nitrogen, creatinine levels were in normal range. Bacterial culture taken from the pustules hadn't reveal any bacterial infection or contamination.
Figure 1: (a) Smooth surfaced, slightly infiltrated, erythematous, oedematous papules, and pustules on the upper body with the extensor areas of bilateral arms. (b) Smooth surfaced, slightly infiltrated, erythematous, oedematous papules, and pustules on the upper body with the extensor areas of bilateral arms

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A skin biopsy was studied from the eruptive lesions with differential diagnosis of acneiform eruption and Sweet's syndrome. Histopathology sections demonstrated an inflammatory neutrophilic infiltration surrounding the deep part of the eccrine glands and vessels of the reticular dermis compatible with NDs [Figure 2]a and [Figure 2]b. Both clinical presentation and histopathology findings in the patient referred us to the diagnosis of NEH. The lesions improved with postinflammatory hyperpigmentation after receiving 6 weeks therapy of oral azythromycin 1500 mg/week [Figure 3]a and [Figure 3]b. During 2 months follow-up, we didn't observe any relapse in the patient.
Figure 2: (a) Inflammatory neutrophilic infiltrate surrounding the deep part of the eccrine glands and vessels of the reticular dermis (H and E × 20). (b) Inflammatory neutrophilic infiltrate surrounding the deep part of the eccrine glands and vessels of the reticular dermis (H and E × 10)

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Figure 3: (a) Improving with flattened papules and postinflammatory erythema and hyperpigmentation after azithromycin treatment. (b) Improving with flattened papules and postinflammatory erythema and hyperpigmentation after azithromycin treatment

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NEH is one of the self-limiting, benign featured of disease in the NDs group. The diagnosis depends on histological features and findings usually refer to neutrophilic infiltration around the eccrine sweat glands.[2] AZA is one of the therapeutic options in the treatment of NDs, yet it is an associated factor to trigger NDs cases though.[3] We preferred to use azithromycin as it is an antimicrobial drug in the macrolide group that is also known for its anti-inflammatory effects.[4] To our knowledge, there is only one case reported in the literature where NEH is seen in a patient with Crohn's disease.[5]

We report this case to demonstrate that dermatological conditions such as NDs and specifically NEH may occur during inflammatory diseases such as Crohn's disease. Although it is a rare disease, dermatologists confronting NDs may consider NEH in cases with an ongoing inflammatory disease simultaneously.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Copaescu AM, Castilloux JF, Chababi-Atallah M, Sinave C, Bertrand J. A classic clinical case: Neutrophilic eccrine hidradenitis. Case Rep Dermatol 2013;5:340-6.  Back to cited text no. 1
    
2.
Bachmeyer C, Aractingi S. Neutrophilic eccrine hidradenitis. Clin Dermatol 2000;18:319-30.  Back to cited text no. 2
    
3.
Bagherani N, Smoller BR. Association of neutrophilic dermatoses with autoimmune connective tissue disorders: a real concept or an accident coincidence? Glob Dermatol 2016. DOI: 10.15761/GOD.1000S1009.  Back to cited text no. 3
    
4.
Akhyani M, Ehsani AH, Ghiasi M, Jafari AK. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of rosacea: A randomized open clinical trial. Int J Dermatol 2008;47:284-8.  Back to cited text no. 4
    
5.
García-Martín P, Sánchez-Pérez J, Fraga J, García-Diez A. Neutrophilic eccrine hidradenitis in a patient with Crohn's disease and azathioprine hypersensitivity syndrome. J Eur Acad Dermatol Venereol 2014;28:1830-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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