Probable Association Between Hidradenitis Suppurativa and Inflammatory Bowel Disease: A Case Report

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by recurrent painful nodules, abscesses, and sinus tracts primarily affecting intertriginous areas, causing significant quality of life impairment. Follicular occlusion, microbial infection, aberrant immune responses, and genetic and environmental factors are all recognized as playing a significant role in its complex pathogenesis. On the other hand, inflammatory bowel disease (IBD) is a relapsing and remitting disorder characterized by chronic inflammation at various sites in the gastrointestinal tract. The pathogenesis of IBD is a multifaceted interplay between genetic susceptibility, dysregulated immune responses, environmental triggers, and gut microbiota alterations, or dysbiosis. Herein, we present a case of a 64-year-old man with longstanding HS, chronic colostomy, and multiple comorbidities who presented with acute bright red blood per rectum. Our extensive workup revealed multiple perianal open fistulous tracts with scarring, large external hemorrhoids, active chronic proctitis with focal crypt abscess formation and erosion, and diverticulitis with negative infectious workup. His HS remained active throughout the hospitalization. Given the combination of chronic skin lesions, active proctitis on histology, and elevated inflammatory markers, these findings raised concern for underlying IBD, although definitive diagnosis required further outpatient evaluation. This report explores the diagnostic challenges at the crossroads of HS and potential IBD.