From Chronic Inflammation to Metastatic Challenge: A Complex Intersection of Hidradenitis Suppurativa, Hypercalcemia, and Squamous Cell Carcinoma

Document Type

Conference Proceeding

Publication Date

9-27-2024

Publication Title

J Bone Miner Res

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that impacts hair follicles and often involves apocrine-rich, intertriginous skin regions. HS presents with relapsing, recurrent inflamed skin lesions that develop into draining abscesses, fibrosis, and disfiguration. Squamous cell carcinoma occurs in 4.6% of HS. Hypercalcemia associated with cutaneous carcinomas is rare in association with HS. We report a patient with parathyroid hormone-related protein (PTH-RP) driven hypercalcemia and squamous cell carcinoma arising from HS. A 66-year-old male presented to the hospital with decreased oral intake and confusion. His medical history was significant for atrial fibrillation and HS of the groin and perineum complicated by previous admissions for sepsis. He was admitted one month prior for sepsis due to an HS flare where he was incidentally noted to have new-onset hypercalcemia of 13.1 mg/dL. He was treated with IV fluids, calcitonin, and Zoledronic acid. The etiology of his hypercalcemia was not evaluated at that time. Workup this admission revealed leukocytosis of 40.8 k/UL, hypercalcemia of 15.1 mg/dL, ionized calcium of 1.94 mmol/L, low PTH of 2.0 pg/mL, elevated PTH-RP of 27 pg/mL, normal vitamin D and angiotensin converting enzyme. CT of the abdomen revealed irregular thickened skin with soft tissue gas within the perineum, scrotum and gluteal soft tissue, concerning for Fournier's gangrene. CT of the chest showed diffuse metastatic disease involving the right sixth and tenth ribs, para-aortic lymph nodes, pulmonary nodules, and likely malignant bilateral pleural effusions with incidental pulmonary emboli. He was admitted to ICU with septic shock and promptly started on broad spectrum antibiotics. Dermatology was concerned for potential transformation of his known HS into metastatic squamous cell carcinoma (SCC). This was confirmed on biopsy of perineal skin which revealed moderately to well-differentiated squamous cell carcinoma. His hypercalcemia was managed with IV fluids and Zoledronic acid. Unfortunately, the patient passed due to cardiac arrest one month later. This case demonstrates the significance of early recognition of hypercalcemia as a potential harbinger of cancer and the importance of considering transformation of chronic skin conditions into SCC in the setting of newly diagnosed hypercalcemia. In this case, humoral hypercalcemia of malignancy due to PTH-RP production from transformed HS into metastatic SCC was identified.

Volume

39

First Page

80

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