Hidradenitis Suppurative

A.P. is a 61-year-old Caucasian male new patient with severe buttock infection after recent outpatient I&D, now on doxycycline 100 mg BID x14 days. He reports multiple open buttock wounds with copious foul-smelling green/yellow purulent drainage (soaking an adult brief every 2–3 hours) and severe, function-limiting pain with sitting, walking, and driving; his colorectal surgeon is aware. History notable for hidradenitis suppurativa previously controlled on adalimumab (Humira), but off ~6 months due to insurance, with worsening disease and persistent malaise/weakness. He denies fever, chills, sweats, chest pain, shortness of breath, abdominal pain, bowel/bladder changes, or weight loss.