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Tinnitus and lack of efficacy: case report A 39-year-old man developed tinnitus during treatment with clindamycin and doxycycline for hidradenitis suppurativa (HS) complicated with scrotal elephantiasis. Additionally, he exhibited lack of efficacy during treatment with clindamycin and doxycycline for HS complicated with scrotal elephantiasis. The morbidly obese man, with a history of smoking, had HS for 20 years, which was complicated with scrotal elephantiasis for 3 years. Additionally, he had history of iron deficiency anaemia secondary to chronic blood loss, positive fecal occult test, gastritis, Helicobacter pylori, hyperplastic polyp in the sigmoid colon and benign polyp in the duodenal bulb. Previously, he had received three iron infusions and ferrous sulfate between the infusions. He first presented to dermatology outpatient clinic 3 years previously. Based on the clinical features and appearance of the lesions the diagnosis of HS was made. At current presentation in 2019, his HS primarily affected the penis, scrotum (scrotal elephantiasis), bilateral groin, lower abdomen and buttock regions and is classified as Hurley Stage III. According to the North American clinical management guidelines for HS, he received various oral antibacterials [antibiotics] including doxycycline 100mg twice daily and two separate attempts of clindamycin 150mg daily for 2 months and 300mg twice daily for 3 months. However, no improvement was noted on these treatments. Meanwhile, he developed tinnitus as a side-effect, which was attributed to doxycycline and clindamycin [duration of treatments to reaction onset not stated]. For flares, he received metronidazole, moxifloxacin and rifampin. For wound care, he received Hydrofera Blue dressings with silver alginate [sic]. The man was started on adalimumab and silver sulfadiazine [silvadene] with benefit in his HS lesions. He had been dependent on a Foley catheter for one and a half year due to massive scrotal oedema leading to penis inversion. His scrotal oedema was attributed to HS. His condition was further complicated by an infection of the scrotal, perineal and penile areas. Cultures tested positive for Pseudomonas aeruginosa, Acinetobacter baumannii complex, Escherichia coli and Corynebacterium species. Therefore, he underwent debridement of the infected skin with a split-thickness skin graft that has healed well. He was actively exercising and controlling his diet for weight management, and received medications including phentermine and topiramate [outcome of ADR not stated]. Snyder SN, et al. Hidradenitis Suppurativa and Scrotal Elephantiasis Case Report. Journal of the Dermatology Nurses’ Association 12: 170-172, No. 4, Jul-Aug 2020. 803505210 Available from: URL: http://doi.org/10.1097/JDN.0000000000000552

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Reactions 3 Oct 2020 No. 1824