Adalimumab-induced facial erysipelas and its successful resolution with azithromycin in a 19-year-old female

A 19-year-old female with severe hidradenitis suppurativa (HS), treated with adalimumab for 10 months, developed facial erysipelas following an episode of pharyngitis. The infection presented with fever, severe cough, and a rapidly progressing erythematous plaque with edema on the left cheek, forehead, and periocular region. Laboratory tests confirmed a streptococcal infection. Due to allergies and intolerance to first-line antibiotics, azithromycin was administered, leading to complete resolution. This case highlights the increased risk of severe infections in immunosuppressed patients and underscores the importance of careful antibiotic selection and close monitoring for infections in patients receiving TNF-α inhibitors.