ABSTRACT NUMBER: ESOC2026A561 WATERSHED INFARCTS IN A PATIENT WITH HIDRADENITIS SUPPURATIVA: EXPANDING THE SPECTRUM OF CEREBROVASCULAR RISK

Abstract Background and aims Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease increasingly recognized as a systemic condition associated with cardiovascular morbidity. Although population-based studies suggest an elevated risk of ischemic stroke in patients with HS, individual cerebrovascular case reports remain rare, and underlying mechanisms are poorly defined. Case A 48-year-old man with uncontrolled diabetes, hypertension, hyperlipidemia, and active tobacco use presented with six days of progressive aphasia and right-sided weakness. CT angiography revealed tandem occlusion of the left cervical and intracranial internal carotid artery, along with severe stenosis of the left vertebral artery origin. Brain MRI demonstrated multiple small acute watershed infarcts in the left cerebral hemisphere, consistent with hypoperfusion mechanism in the setting of large-vessel disease. Transthoracic echocardiography was unremarkable. During hospitalization, the patient developed sepsis secondary to recurrent cutaneous abscesses. Dermatologic evaluation led to a new diagnosis of hidradenitis suppurativa, and antimicrobial therapy with doxycycline and amoxicillin-clavulanate was initiated. Neurological deficits improved with standard stroke care, and secondary prevention focused on aggressive vascular risk factor modification and smoking cessation. Conclusions This case highlights hidradenitis suppurativa as a potential contributor to ischemic stroke through systemic inflammation, endothelial dysfunction, and prothrombotic mechanisms, particularly in the presence of large-vessel disease and superimposed infection. The occurrence of watershed infarcts underscores the importance of recognizing HS as a systemic inflammatory condition with cerebrovascular implications. Increased awareness among stroke physicians may improve risk stratification and preventive strategies in patients with HS and traditional vascular comorbidities. Conflict of interest Curtis Amankwah: nothing to disclose