Two Cases of Mycetoma-like Hidradenitis Suppurativa

While the differential for hidradenitis suppurativa (HS) includes metastatic Crohn’s disease in certain patients, few reports exist in the literature of hidradenitis presenting similarly to mycetoma. Herein, we discuss two male patients (57 and 38 years old) with Crohn’s disease presenting with chronic, painful gluteal nodules, draining sinus tracts, and scarring concerning for mycetoma, metastatic Crohn’s disease, or HS. Biopsies were consistent with HS with no evidence of Crohn’s disease. Triple wound cultures for both patients were negative. However, one patient’s (57 M) fungal culture was positive for Aspergillus sclerotiorum, but a referral to Infectious Disease concluded that concern for Aspergillus mycetoma was low. Following thorough workup, both patients were diagnosed with HS and were started on adalimumab for dual Crohn’s and hidradenitis therapy. The first patient (57 M) had already experienced improvement of his gluteal lesions on this regimen at his one-month follow-up appointment. The second patient (38 M) had been prescribed adalimumab in early 2024 but only received one injection due to delivery scheduling challenges. He was recently reinitiated on the medication. Overall, we highlight two cases of hidradenitis suppurativa presenting similarly to mycetoma and treated with adalimumab.