SHM Converge Scientific Abstract ePoster Gallery-Pyoderma Gangrenosum, Acne and Suppurativa Hidradenitis (Pash) Syndrome

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A 40-year-old woman with a history of acne vulgaris and hidradenitis suppurativa presented with 6 months of worsening bilateral lower-extremity edema, pain, and ulcerating sores. She had two prior hospitalizations for severe suppurative hidradenitis complicated by abscesses. On arrival, she was tachycardic and mildly hypotensive but afebrile, with multiple markedly tender erosive lesions on her extremities. Initial labs showed elevated inflammatory markers (CRP 13.5, ESR 130) with normal WBC, and MRV ruled out deep vein thrombosis. She was started on vancomycin, piperacillin-tazobactam, and supportive care, then transferred for dermatology and burn evaluation.<br /><br />During the hospital course, dermatology diagnosed the triad of pyoderma gangrenosum, acne, and suppurative hidradenitis, consistent with PASH syndrome. She was treated with high-dose IV methylprednisolone (80 mg daily). Infectious evaluation, including hepatitis testing and QuantiFERON gold, was negative, and infliximab was initiated. Antibiotics were later tapered as her symptoms improved.<br /><br />The case highlights PASH syndrome, a rare autoinflammatory disorder characterized by pyoderma gangrenosum, acne, and hidradenitis suppurativa. It is thought to involve dysregulation of inflammatory pathways, including elevated IL-1 and TNF. Patients often develop severe acne and recurrent hidradenitis in young adulthood, while pyoderma gangrenosum may appear later. Treatment typically centers on immunosuppression with systemic corticosteroids and anti-TNF therapy such as infliximab.

Asset Subtitle

Andrew L. Wu

Meta Tag

Author List Andrew L. Wu, Ziad Sad Aldeen

Category Clinical Vignettes

Concept PASH Syndrome

Concept Pyoderma Gangrenosum

Concept Suppurative Hidradenitis

Concept Infectious Workup

Concept Systemic Corticosteroid

Distinguished Non-Finalist

Presenter Organization University of Wisconsin

Presenting Author Andrew L. Wu

Track Adult

Keywords

PASH syndrome

pyoderma gangrenosum

hidradenitis suppurativa

acne vulgaris

infliximab

methylprednisolone

autoinflammatory disorder

lower-extremity edema

ulcerating sores

TNF inhibition

PASH Syndrome

Pyoderma Gangrenosum

Suppurative Hidradenitis

Infectious Workup

Systemic Corticosteroid