SHM Converge Scientific Abstract ePoster Gallery-More Than Skin Deep: Stroke Secondary to Hidradenitis Suppurativa

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This case report describes a 28-year-old active-duty Black woman who presented with sudden left-sided weakness and sensory changes consistent with an acute ischemic stroke. Initial CT/CTA imaging was unremarkable, but MRI confirmed a right-sided infarct correlating with her deficits. A broad stroke, infectious, metabolic, and mitochondrial workup was negative except for elevated inflammatory markers (ESR and CRP). She was discharged on aspirin, a high-intensity statin, and advised to stop combined oral contraceptives.<br /><br />At neurology follow-up, she was found to have multiple inflamed axillary and inguinal cysts and was referred to dermatology, where she was diagnosed with Hurley stage 3 hidradenitis suppurativa (HS). She was treated with clindamycin and rifampin, then started on adalimumab because of severe disease and concern that chronic HS-related inflammation contributed to her stroke risk. With physical therapy, she made a full neurologic recovery.<br /><br />The discussion emphasizes that HS is a chronic inflammatory skin disease affecting about 1% of the U.S. population and is more common in women, middle-aged adults, and Black individuals. Beyond skin disease, HS is linked to increased cardiovascular risk, including myocardial infarction and ischemic stroke, even after accounting for traditional risk factors. Published data suggest women with HS have a 33% increased stroke risk, and young adults aged 18–29 with HS may have a 67% increased risk.<br /><br />The proposed mechanism involves follicular occlusion, rupture, altered skin microbiome, and a resulting systemic inflammatory response. The report concludes that clinicians should consider HS as a contributor to ASCVD risk in young patients and include ischemic stroke in the differential diagnosis of cryptogenic stroke, especially in young women.

Asset Subtitle

Ashley M. Otto

Meta Tag

Author List Ashley M. Otto, Michael Burns

Category Clinical Vignettes

Concept Suppurative Hidradenitis

Concept Ischemic Stroke

Concept Cryptogenic Stroke

Concept Cardiac Risk

Concept Cerebrovascular Risk

Distinguished Non-Finalist

Presenter Organization Naval Medical Center Portsmouth

Presenting Author Ashley M. Otto

Track Adult

Keywords

ischemic stroke

hidradenitis suppurativa

cryptogenic stroke

systemic inflammation

young woman

MRI infarct

elevated ESR

elevated CRP

adalimumab

cardiovascular risk

Suppurative Hidradenitis

Ischemic Stroke

Cryptogenic Stroke

Cardiac Risk

Cerebrovascular Risk