PURPOSE: To report a patient who presented with bilateral interstitial keratitis 
in association with severe hidradenitis suppurativa.
METHODS: Case report.
RESULTS: An 18-year-old African American woman with severe active hidradenitis 
suppurativa of the axillae and groin presented with a 2-week history of 
bilateral blurry vision. On examination, best-corrected visual acuity was 
counting fingers in the right eye and 20/70 in the left eye. Slit-lamp 
examination revealed diffuse vascularization of the corneal stroma with 
surrounding infiltrates bilaterally. In the left eye, corneal thinning and an 
epithelial defect were present in an area of infiltrate. Our clinical impression 
at that time was bilateral interstitial keratitis with secondary bacterial 
keratitis in the left eye. Topical therapy, prednisolone acetate 1% in the right 
eye, and ofloxacin in the left eye, was instituted. A systemic workup, including 
antinuclear antibody, rheumatoid factor, Lyme titer, cytoplasmatic staining 
antineutrophil cytoplasmic antibodies, perinuclear staining antineutrophil 
cytoplasmic antibodies, erythrocyte sedimentation rate, Venereal Disease 
Research Laboratory, rapid plasma reagin, basic metabolic panel, 
angiotensin-converting enzyme level, and a chest x-ray was negative. Topical 
steroids were used in the left eye after resolution of the bacterial keratitis. 
The interstitial keratitis responded to topical steroids and remained in 
remission after steroid taper. However, bilateral interstitial keratitis 
recurred coincident with a severe flare of hidradenitis suppurativa within 1 
month of discontinuing the topical steroids. A course of subcutaneous adalimumab 
injections (40 mg/mL every 2 weeks) for hidradenitis suppurativa was 
implemented. Both her dermatological and ocular conditions responded to this 
therapy and have remained in remission through 7 months of follow-up.
CONCLUSIONS: Hidradenitis suppurativa is a rare cause of bilateral interstitial 
keratitis. Patients may experience simultaneous exacerbations of both 
dermatological and ocular manifestations. Systemic treatment with adalimumab can 
improve both dermatological and ocular conditions.