Concurrent Hidradenitis Suppurativa and Pyoderma Gangrenosum in a Pediatric Cohort: A Retrospective Case Series
Bibliographic record
Abstract
Background: Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are chronic neutrophilic dermatoses characterized by dysregulated inflammation. Their coexistence in adults has been reported, but this has not been well documented in pediatric populations. Objectives: To characterize the overlap, clinical characteristics, and treatment options for pediatric patients with concurrent HS and PG. Methods: We conducted a retrospective case series of pediatric patients ages 3 to 17 with clinical diagnoses of HS and PG at The Hospital for Sick Children between January 2015 and January 2022. Demographic, clinical, laboratory, genetic, and treatment data were extracted from electronic medical records and analyzed descriptively. Results: Seven of 122 pediatric HS patients (5.7%) had concurrent PG. HS onset preceded PG in all cases, with mean onset ages of 11.6 and 16.1 years, respectively. The cohort had a slight male predominance (57%) and high rates of comorbidities, including obesity (71.4%) and acne conglobata (42.9%). Elevated erythrocyte sedimentation rate (ESR) (mean 56.9 mm/hour) was a significant predictor of HS severity ( P = .027). Three patients had autoinflammatory gene variants, and 57.1% met criteria for PASH or PAPA syndrome. Cytokine profiling revealed elevated IL-1β and IL-6 in select cases. Three of 4 patients who underwent incision and drainage for HS developed PG at the surgical sites. Conclusions: Pediatric patients with HS-PG may represent a distinct, severe inflammatory subset. Further investigation is needed to define risk factors, inflammatory biomarkers, and optimal treatment strategies in this rare overlap population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".