Hidradenitis supparativa complicated by penoscrotal lymphedema and renal amyloidosis

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Figure 1
- Penoscrotal lymphedema.
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Figure 2
- Mild hidradenitis supparativa with only post inflammatory hyperpigmentations. He gets occasional small nodules that get resolved with topical treatment.
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Figure 3
- A glomerulus shows: A) abundant mesangial as well as capillary wall deposits of amorphous eosinophilic material (H&E - x400). B) The deposited material is silver negative (JMS-x400). C) Congo red stain revealed apple green birefringence under polarized light (Congo red-x400). D) The tufts are strongly positive for amyloid associated protein (immunoperoxidase, AA protein-x400).

Table 1

- Patient’s summarized timeline.

Dates	Relevant past medical history and interventions
Dates	Diagnostic testing	Intervention
March 2017	Adalimumab was considered, but latent tuberculosis was detected	Full anti-tuberculosis regimen
December 2018	Purified protein derivative test was negative	Adalimumab was initiated
January 2020	-	Adalimumab was discontinued due to reoccurring spikes of fever
August 2020 (At the time of patient presentation)	Renal function test showed elevated serum creatinine and urine protein. Renal biopsy showed stage V chronic kidney disease secondary to advanced renal amyloidosis	Prednisolone, and reintroduction of adalimumab was considered to treat both his HS and renal amyloidosis. The patient was also referred to general surgery to manage his genital lymphedema.