More Than Skin Deep: A Case of Stroke Secondary to Hidradenitis Suppurativa

Area of Science:

• Rheumatology
• Neurology
• Dermatology

Background:

• Cryptogenic ischemic strokes in young adults lack identified causes.
• Systemic inflammatory diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are linked to early atherosclerotic cardiovascular disease (ASCVD).
• Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with shared inflammatory pathways but is underrecognized as a cardiovascular risk factor.

Purpose of the Study:

• To highlight Hidradenitis Suppurativa (HS) as a potential cause of cryptogenic ischemic stroke.
• To emphasize the importance of recognizing HS as a systemic disease with cardiovascular and neurological implications.
• To underscore the need for early diagnosis and treatment of HS to mitigate long-term morbidity.

Main Methods:

• Case report of a 28-year-old active-duty service member with cryptogenic ischemic stroke.
• Initial comprehensive evaluation including vascular imaging, echocardiography, telemetry, autoimmune, and coagulation testing.
• Diagnosis of advanced HS (Hurley stage III) and treatment with adalimumab during follow-up.

Main Results:

• The patient's ischemic stroke was initially classified as cryptogenic.
• Advanced HS was diagnosed post-stroke.
• Treatment with adalimumab resulted in dermatologic improvement and prevented further neurological events.

Conclusions:

• Hidradenitis Suppurativa (HS) should be considered a potential cause of cryptogenic ischemic stroke due to chronic systemic inflammation.
• Recognizing HS as a systemic disease is critical for managing its cardiovascular and neurological effects.
• Early diagnosis and treatment of HS may reduce long-term morbidity, particularly in young military populations.