Polyclonal Hypergammaglobulinemia in Severe Hidradenitis Suppurativa

This is the case of a 36-year-old man with a 15-year history of Hurley stage III hidradenitis suppurativa (HS) who presented with painful nodules, chronic drainage, and extensive sinus tracts involving the axillae, groin, and gluteal cleft. The patient had previously failed multiple systemic and procedural therapies, including oral antibiotics, intralesional corticosteroids, adalimumab, and methotrexate. Physical examination demonstrated hypertrophic scarring, purulent discharge, and diffuse inflammatory activity. Laboratory evaluation revealed marked polyclonal hypergammaglobulinemia (pHGG), a finding whose association with HS is increasingly reported but remains incompletely understood. Therefore, we present an interesting case of severe, refractory HS with pHGG that improved after infliximab treatment, along with a brief discussion of relevant literature.