Severe Hidradenitis Suppurativa and Subsequent Myelodysplastic Syndrome: A Case Report Highlighting Chronic Inflammatory Burden and Carcinogenic Risk.

Hidradenitis suppurativa (HS) is a systemic inflammatory disease associated with an increased risk of malignancies, in which chronic inflammation and immune dysregulation have been proposed as contributing factors. We report the case of a 22-year-old male with severe follicular occlusion tetrad (Hurley III) since pre-puberty (age 11), who developed severe cytopenias at age 16, subsequently diagnosed with myelodysplastic neoplasm. Despite extreme transfusion dependence (>110 cumulative units of red cells and platelets over six years) and persistent bone marrow failure, treatment with Ixekizumab (anti-IL-17A) achieved significant cutaneous improvement, reducing the International Hidradenitis Suppurativa Severity Score (IHS4) from 21 to 11. This case highlights a possible association between long-standing severe HS and myeloid disease, suggesting a biologically plausible link between chronic cutaneous inflammation and myeloid dysfunction. Although late inflammatory control resulted in meaningful dermatologic improvement, it did not reverse established bone marrow failure, emphasizing the importance of early intervention and hematological surveillance in patients with severe HS.