Hidradenitis suppurativa: evidence for a bactericidal defect correctable by cholinergic agonist in vitro and in vivo

Hidradenitis suppurativa (HS) affects the apocrine sweat glands, giving chronic recurrent abscesses of axillary and perineal areas. We report a patient who had a defect in polymorphonuclear leukocyte killing of bacteria associated with low levels of intracellular cyclic GMP. This defect was corrected with a cholinergic agonist in vitro. Treatment of the patient with a cholinergic agonist, bethanechol chloride, resulted in prolonged clinical improvement, normal bactericidal function, and normal levels of intracellular cyclic GMP. The possible mechanisms responsible for the bactericidal defect and for the patient's improvement are discussed.