ro13-9904 and Hidradenitis-Suppurativa

Although hidradenitis suppurativa (HS) is not primarily an infectious disease, antibiotics are widely used to treat HS. Recent microbiological data show that HS suppurating lesions are associated with a polymorphous anaerobic flora, including actinomycetes and milleri group streptococci, and can therefore be considered as polymicrobial soft tissue and skin infections. Analysis of the literature provides little information on the efficacy of antibiotics in HS but suggests a beneficial effect of certain antimicrobial treatments, depending on the clinical severity of the disease. Patients must be informed and should agree with the treatment strategy before starting antibiotic treatments.

Topics: Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Clindamycin; Drug Therapy, Combination; Ertapenem; Fluoroquinolones; Hidradenitis Suppurativa; Humans; Imipenem; Maintenance Chemotherapy; Metronidazole; Moxifloxacin; Remission Induction; Rifampin

Hidradenitis suppurativa (HS), which is characterized by the obstruction of the apocrine gland channels and development of secondary bacterial infections, is a rare clinical entity mostly seen in women. In this case report, a bacterial meningitis case, which emerged after HS in the gluteal region, was presented. To the authors' knowledge this is the first case in the literature. Sixty-years-old male patient was admitted to the infectious disease department with high fever, lack of consciousness and orientation and cooperation problems. Upon detection of neck stiffness during physical examination, cerebrospinal fluid (CSF) specimen was taken. CSF analysis revealed increased pressure, turbidity, (++++) Pandy reaction and 33.600/ml leucocytes (95% PMNL). CSF glucose was 2 mg/dl (simultaneous blood glucose was 156 mg/dl) and protein was 360 mg/dl. Gram stained smear of the CSF specimen yielded high numbers of gram-positive cocci. Empirical treatment with intravenous ceftriaxone (2 x 2 g/day) and linezolid (2 x 600 mg/day) was initiated upon the diagnosis of acute bacterial meningitis. Physical examination of the patient revealed HS characterized by common fistulas in gluteal area and drainage from the fistula with drainage in left gluteal area. White blood cell blood count was 26.700/mg, platelet count was 501.000/ml and hemoglobin was 14.8 mg/dl. Erythrocyte sedimentation rate was 120 mm/hour. In the magnetic resonance imaging of the vertebra, fistula tract was determined between inflammed tissue and sacral subarachnoid region. Since the culture of CSF and blood did not yield any growth, the probable causative agent was thought to be an anaerobic gram-positive coccus. The treatment continued for 21 days for ceftriaxone and 28 days for linezolid. The patient was successfully treated and was transferred to neurosurgery department without any sequela for the management of fistulas.

Topics: Acetamides; Anti-Bacterial Agents; Anti-Infective Agents; Buttocks; Ceftriaxone; Cerebrospinal Fluid; Gram-Positive Cocci; Hidradenitis Suppurativa; Humans; Linezolid; Male; Meningitis, Bacterial; Middle Aged; Oxazolidinones