Hidradenitis suppurativa with systemic autoinflammatory features in patients of Moroccan origin: case report and implications for personalized medicine

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting intertriginous regions, and emerging evidence suggests that systemic autoinflammation (“metainflammation”) contributes to its clinical heterogeneity. We report two cases of HS in patients of Moroccan origin with overlapping autoinflammatory features. The first case involves a 42-year-old man with HS since 2012, Hurley stage II, treated with adalimumab since 2019 and achieving an IHS4-70, who developed Behçet’s disease-like systemic manifestations in 2025; genetic testing revealed a heterozygous MEFV variant, and HLA typing included A02, A68, B15, B45, C02, and C06. The second case involves a 40-year-old man with HS since age 22, Hurley stage II, with persistent oral aphthosis; he achieved IHS4-70 on secukinumab in 2025 and responded to adjunctive colchicine for mucosal lesions, with HLA typing showing B18, B51, C07, and C15. These cases illustrate the interplay between HLA subtypes, autoinflammatory gene variants, and systemic inflammation in HS, highlighting a potential autoinflammatory HS subtype. Population-specific genetic factors, particularly in North African populations, may influence disease severity, systemic manifestations, and therapeutic response. Taken together, these observations support the concept that HS, in certain genetically predisposed individuals, may represent a systemic autoinflammatory/metainflammatory disease, underscoring the relevance of personalized therapeutic strategies.