Undiagnosed Hidradenitis Suppurativa Associated with Acute Myocardial Infarction: A Case Report

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease believed to be a risk factor for cardiovascular events. Traditional cardiovascular risk factors, such as metabolic syndrome, often coexist with HS. Chronic inflammatory conditions may underlie cardiovascular events in young patients or those with few traditional risk factors. A 34-year-old female was admitted to the authors’ tertiary care hospital with acute anterior ST-segment elevation myocardial infarction, and underwent a successful primary percutaneous coronary intervention to their left anterior descending artery. They were a smoker, had a high BMI, and had a positive family history of premature coronary artery disease. During their admission, the patient disclosed that they had discharging lesions under their left breast. The patient had a long-standing history of multiple discharging lesions alternating with disfiguring scars that had started in their late childhood; however, despite this leading to self-dissatisfaction, they did not seek medical advice. Examination revealed plaques and scarring in both axillae and a chronic abscess under the left breast, the swabs from which were sterile, as is consistent with HS. The laboratory results showed a raised troponin and white cell count with mildly elevated levels of C-reactive protein. The patient was managed with standard acute coronary syndrome treatment and a course of oral doxycycline, and awaits further treatment by dermatology and plastic surgery. The morbidity of HS is grossly underestimated. This case study highlights that HS has significant cardiovascular implications, in addition to psychological impacts, and that underlying systemic inflammation may promote rapid atherosclerosis. Further research into pathogenesis and strategies to prevent adverse cardiovascular events are needed.