Radical Surgery for Successful Management of Axillary Hidradenitis Suppurativa Complicated by Mycobacterial Infections

Abstract

Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-yearold female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last 5 years. Earlier, she had received a 6 month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for 3 months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical excision of all the tracts, fistulae, and sinuses over her axilla was performed under ultrasound guidance. Wide excision resulted in a significant axillary defect that was reconstructed with large advancement flaps aided by progressive tension sutures. Postoperatively, a 7 year follow-up period of the patient was disease-free with the patient taking all necessary precautions. After 7 years, the affected axilla appeared nearnormal with some areas of stretched scars that did not bother the patient. To conclude, HS with Non tuberculous mycobacteria is rare, and a proper antimicrobial therapy with early en bloc excision under ultrasound guidance produced a complete cure.