Supplementary Material for: Hidradenitis Suppurativa Presenting with Ocular Manifestations in a 44-Year-Old Male: A Case Report

Introduction Οcular manifestations of hidradenitis suppurativa (HS) are uncommon and typically include episcleritis, keratitis, and uveitis. We report a rare case of posterior scleritis and peripheral ulcerative keratitis (PUK) in a patient with HS. Case Presentation A 44-year-old male with no significant systemic or ocular history presented with a painful corneal ulcer in the left eye, which was diagnosed as PUK. External examination showed facial scarring and only in the course and only during subsequent visits did he reveal his axillary lesions. Initial eye treatment with topical antibiotics and steroids led to marked improvement. Two weeks later, the patient developed pain in the left eye and was diagnosed based on clinical findings of posterior scleritis, which was confirmed by B-scan ultrasonography. Concurrent worsening of HS and the presence of a conjunctival granuloma. A conjunctival biopsy was performed alongside a comprehensive systemic work-up, both of which excluded infectious etiologies and systemic rheumatological autoimmune disease The patient responded well to systemic corticosteroids and continues to demonstrate stable vision and ocular health during follow-up. Over the course of his disease, he was diagnosed with peripheral ulcerative keratitis and anterior scleritis in both eyes, with the addition of posterior scleritis in the left eye. Treatment at this stage included topical dexamethasone, tobramycin, and systemic corticosteroids. Marked improvement in ocular symptoms and visual acuity was achieved. Histopathological analysis of the conjunctival biopsy revealed a benign histiocytic granuloma without evidence of malignancy or Splendore-Hoeppli phenomenon. No systemic rheumatologic autoimmune disease, including sarcoidosis, was identified. Conclusion: This case highlights the importance of recognizing ocular involvement in HS, particularly posterior scleritis and PUK, which may indicate underlying autoinflammatory dysregulation. Interdisciplinary management is essential for preserving vision. To our knowledge, this is the first report of posterior scleritis, PUK and conjunctival granuloma in the context of HS.