case_images: PMC11745271_01
case_images: Upon clinical presentation, both patient 1 (A-B) and patient 2 (C) exhibited ulcerative acneiform lesions on their chest, leading to a diagnosis of acne fulminans.
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case_images: Both twins had inflammatory nodules, comedones, pustules as well as painful hemorrhagic ulcers with adherent crusts on the back, chest and occipital region (Fig. 1).
case_images: Patient 1: Axial Short Tau Inversion Recovery (STIR) MRI images (left) of the chest revealing nodular hyperintensity signals in the cutaneous-subcutaneous region affecting the anterior chest wall as well as the back (A); hyperintensity signal of the posterior arch of the fourth rib on the right due to marrow edema but no edema of the surrounding soft tissues (B). Coronal Diffusion-Weighted Whole-Body Imaging with Background Body Signal Suppression (DWIBS) images (right) demonstrating increased signal at the level of multiple subcutaneous alterations of the patient's back (C); focal hyperintensity signal at the left sacroiliac joint (D).
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case_images: Magnetic Resonance Imaging (MRI) of patient 1 showed altered signal intensities of the left sacroiliac joint and of the posterior arch of the fourth rib on the right, while for patient 2, MRI highlighted altered signal intensity at the left sacroiliac joint (Fig. 2).
case_images: After six months, the patient 1 (A-B) and the patient 2 (C) had atrophic scars on their chest and back.
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case_images: After six months, there was a marked improvement in both the acne and HS lesions (Fig. 3).