This case report highlights a rare presentation of a hidradenitis suppurativa (HS) flare occurring concurrently with peripheral ulcerative keratitis (PUK) in a patient with a longstanding history of HS. HS is a chronic inflammatory skin condition known to be associated with various ocular manifestations, including inflammatory eye diseases (IEDs) such as anterior uveitis. Although the link between HS and IED is well documented, the association between HS and PUK is less frequently reported. Previous cases have demonstrated improvement in keratitis among HS patients using treatments ranging from topical steroids to systemic immunosuppressive therapies. In this case, the patient's symptoms resolved with a combination of topical and oral steroids, supporting the hypothesis that HS may underlie the development of PUK in such cases. This report adds to the growing body of evidence connecting HS with ocular complications and underscores PUK as a rare but significant manifestation of the disease.