Uncommon Drug-Induced Hidradenitis Suppurativa: A Case Report of A Patient on Lithium Therapy

Abstract

Hidradenitis suppurativa (HS) is not fully understood and is regarded as a multifactorial condition diagnosed based on clinical evaluation. Smoking, obesity, and hormonal imbalances may be the underlying associations of HS. The incidence of HS is greater in patients with diabetes. Psychiatric illnesses and their medications have been linked to new-onset and worsening of HS. This case report discusses a 35-year-old Hispanic male, a non-smoker with a past medical history of schizophrenia and bipolar disorder, who was diagnosed with axillary HS after initiating lithium therapy. He experienced worsening HS and reached Hurley stage III, for which surgical excision was offered as the definitive treatment. Here, we present a case report of HS after the initiation of lithium therapy, focusing on the underlying pathological process of this skin condition. Despite limited data on this topic, clinical features, management of the condition, and possible disease development prevention methods will be emphasized.

Keywords: acne inversa; bipolar disorder; comorbidities; hidradenitis suppurativa; lithium; nodules; quality of life; schizophrenia.

Figure 1. Pathology of excised right axillary tissue

Hematoxylin and eosin stain

Figure 2. One week post-operative: Healing right axillary wound (15x12x2.5 cm)

Figure 3. Three weeks post-operative: Healing right axillary wound (10x10x0.5 cm)