Issue: 2015 > August > photo quiz

A 68-year-old man with bilateral axillary swelling

S.H.W. van Bree, O.S. Smeekes, A. Borren, A.J.M. van den Eertwegh
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A 68-year-old Caucasian man was referred to our hospital with bilateral axillary swelling (figure 1). The patient had noticed lumps in his armpits four weeks ago. Under suspicion of hidradenitis suppurativa, augmentin was started, but the lumps had increased in size and started to become painful without any accompanying rubor or calor. B-symptoms were absent. Anamnestic findings included a well-treated HIV-positive partner.
Physical examination revealed a node of 7 cm in diameter in the left axilla and of 5 cm in the right axilla. Both nodes were dense and were not connected to any circumferential tissue.
Routine laboratory investigations showed an erythrocyte sedimentation rate of 49 mm/h, haemoglobin 8.7 mmol/l, leukocytes of 9.3 x 109/l with a normal differential count and a serum lactate dehydrogenase of 351 U/l, and transaminase activity within the normal range. A contrastenhanced computed tomography (CT) of the neck, thorax and abdomen was performed.