Axillary sinuses and cervical swellings

Abstract

Conflict of interest: none declared. A 22‐year‐old man was referred with a 3‐year history of bilateral axillary lesions and an 18‐month history of cervical swelling. The patient also complained of weight loss, anorexia, lethargy and intermittent fevers. Examination revealed two tender, fluctuant masses on the left side of the neck with overlying erythema. In addition, there were sinuses in both axillae (Fig. 1a,b). The patient was a refugee from Afghanistan but had been in the UK for the past 3 years. He had no other medical problems and was not on any regular medication. ... Full blood count, renal and liver profiles, and erythrocyte sedimentation rate were normal and a human immunodeficiency virus (HIV) test was negative. Microbiological analysis of axillary pus swabs were negative, and chest X‐ray was normal. Further investigations included a computed tomography scan of the chest, abdomen and pelvis, which revealed apical nonfibrotic lung nodules and extensive axillary lymphadenopathy (Fig. 1c). A biopsy of the cervical swelling was sent for histological and microbiological analysis. An incisional skin biopsy from the left axillary mass was also obtained for histological and microbiological examination. The initial differential diagnosis included lymphoma.