Abstract Ischemic strokes in young adults are often classified as cryptogenic when standard evaluation fails to identify an underlying cause. Growing evidence connects systemic inflammatory diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), to early-onset atherosclerotic cardiovascular disease (ASCVD) that is driven by proinflammatory cytokines and endothelial dysfunction. Hidradenitis suppurativa (HS), a chronic inflammatory skin condition marked by recurrent abscesses and sinus tracts, shares similar inflammatory pathways but remains underrecognized as a cardiovascular risk factor. We report the case of a 28-year-old active-duty service member who presented with acute ischemic stroke after prior transient visual disturbances. Initial evaluation, including vascular imaging, echocardiography, telemetry, autoimmune and coagulation testing, was unrevealing, and the stroke was labeled cryptogenic. At follow-up, advanced HS (Hurley stage III) was diagnosed, and treatment with adalimumab led to both dermatologic improvement and absence of further neurologic events. This case emphasizes HS as a possible cause of cryptogenic ischemic stroke because of chronic systemic inflammation. Recognizing HS as a systemic disease with cardiovascular and neurological effects is critical. Early diagnosis and prompt treatment may lower long-term morbidity, especially in young military populations where early vascular events have major personal and occupational consequences.
Lacasse et al. (Wed,) studied this question.