CASE REPORT CASE AN UNUSUAL PRESENTATION OF HIDRADENITIS SUPPURATIVA: REPORT AND REVIEW OF THE LITERATURE DAVID C. CHAIKIN, M.D. LAWRENCE R. VOLZ, M.D. GREGORY BRODERICK, M.D. From the Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania ABSTRACT--Hidradenitis suppurativa is a chronic suppurative and cicatricial process of apocrine gland-bearing skin. The clinical course can range from mild to severe. We present a case of a urethral fistula and phimosis occurring secondary to hidradenitis suppurativa, and review the literature. Hidradenitis suppurativa (HS) typically involves the axilla and areola of breasts in young women and anogenital regions in men. Although involve- ment of the perineal area is rare, the urologist must be familiar with its occurrence and associated complications. We present a case of HS presenting with a urethral cutaneous fistula with a review of the literature. CASE REPORT A 71-year-old black man presented with painful induration and scrotal drainage as well as diffi- culty initiating micturition. He had been experi- encing these symptoms for several years but had avoided medical attention. Physical examination revealed an uncircumcised penis with retracted foreskin causing phimosis. The scrotal skin and perineum were indurated with a network of sinus tracts that extruded purulent ma- terial. The testes and epididymis were sonograph-~ ically normal. Digital rectal examination revealed normal sphincter tone and a benign-feeling prostate that was nontender. There was no evidence of pri- mary anorectal abscess or fistula. The white blood cell count was 23,000/mm 3 and cultures of the purulent drainage grew coagnlase- positive Staphylococcus and Streptococcus. Urine culture was negative for bacteria and acid-fast bacil- lus. Postvoid residual was 25 mL. A voiding cysto-- Submitted: Mai'ch 2, 1994, accepted (with revisions): May 24, 1994 urethrogram revealed a 5 mm x 8 c: taneous fistula connecting the post, nous urethra to the perineum. Barit colonoscopy were without evidenc~ tory bowel disease. Tests for lym t venereum gave negative results. A circumcision was performed. sinuses were incised and drained. pubic urinal T tube and Foley cathet (Fig. 1). Biopsy specimens of the perineum the rectum were examined. The p~ charged with a suprapubic tube o: cystourethrogram was obtained 2 ing his discharge fiom the hospit~ that the urethral fistula had resolw pubic tube was removed and the without difficulty. All stains for fungi and mycobact{ tive. Following review of the biops) the Armed Forces Institute of Patho sis of HS was confirmed. COMMENT Hidradenitis suppurativa was firs Velpeau in 18331 in a patient with at process involving the axilla, breasl region. Twenty-one years later, Vern a similar process in the surgical lite the first to postulate that it originat, glands. Over the years, multiple re F of patients with this disease have describing extensive experience ant 606 UROLOGY ~ / 0cio~R1994 / VoL