A 35-year-old man is presented with skin lesions over face, thighs, gluteal region, and axilla [Figures 1-3]. As per the patient, he developed nodular skin lesions with foul smelling discharge over face, gluteal region, thighs, and axilla 2 years back. The lesions progressed to form ulcer and scars. The condition responded partially to antibiotic treatment, and the patient suffered from recurrent lesions. He also complained of diarrhea, prolonged fever, and weight loss >10%. Patient had a history of multiple unsafe sexual exposure. There was no history of genital ulcer or discharge.
General examination revealed marked wasting. Inguinal lymphnodes were enlarged, discrete, and nontender. Systemic examination was normal. Multiple nodules, comedons, discharging sinuses, and scarring were present over face, axilla, gluteal region, and posterior thighs. Laboratory investigations: complete blood picture revealed HB 10 g%, total count was low 3000/cumm, differential count showed predominant neutrophils 86/13/1/0, and patient had raised ESR: 70 mm/h. Staphylococcus aureus was isolated in culture. ELISA for HIV was reactive. Due to resource constraints, CD4 count could not be carried out. X-ray and USG abdomen were carried out to study tuberculosis were normal. FNAC of inguinal lymphnodes showed reactive lymphadenitis.
Differential diagnosis considered were HS, Staphylococcal folliculitis, and Eosinophilic folliculitis.
A confirmatory biopsy results showed folliculitis and perifolliculitis with dilated infundibulum containing keratinous material and inflammatory dermis and heavy, mixed inflammatory cell infiltrate consisting of neutrophils, lymphocyte in lower half of dermis suggestive of HS.
Patient was put on oral doxycycline 100 mg BID and ibuprofen. Dapsone 100 mg was added. However, there was partial response with recurrence. Patient had AIDS defining illness, but ART could not be offered as he presented to us in Pre-ART era.