A Dermatologic Emergency Case of Neutrophilic Eccrine Hidradenitis

Neutrophilic eccrine hidradenitis (NEH) is a nonspecific dermatologic lesion pattern presenting as erythematous papules and plaques. In this case report, we present a patient diagnosed with NEH at the emergency department (ED) without any history of malignancy, chemotherapy, drug reactions, or systemic inflammatory disease. A 29-year-old man presented to our ED with complaints of fever, bilateral localized axillary skin rash, and pain. He stated that his complaints had started two days before admission. At the initial examination, he had tender and polymorphic erythematous papules in the bilateral axillae. A complete blood count showed leukocytosis (10,970/mcl), and the C-reactive protein (CRP) value was increased (6.6 mg/dl). We did not detect any other physical examination findings that could be related to infection. After being prescribed a non-steroidal anti-inflammatory drug and systemic antibiotics, the patient was referred to the dermatology clinic for further evaluation. During the dermatologic consultation, a 4-mm punch biopsy was performed of the patient's right axilla. Histopathology revealed neutrophil infiltration, nuclear pyknosis, and cytoplasmic eosinophilia in the eccrine glandular epithelium, which confirmed the diagnosis of NEH. NEH is a real dermatologic emergency that emergency physicians must be able to recognize and evaluate in ED settings. Although skin biopsy is the key element of diagnosis, detailed physical examinations, laboratory tests, and skin cultures should be performed. Furthermore, fever should be accepted as a criteria for the administration of systemic antibiotics.