Axillary swelling and a reduced general condition in a middle-aged man

Abstract

A 48-year-old man presented to his GP with an indolent swelling in his left axillary region. He also complained of a cough, a feeling of pressure in his chest, general poor health, and had increasingly suffered from night-time sweating and fever. Physical examination and an ultrasound revealed an enlarged lymph node of almost 4 cm in the left axillary region and several smaller lymph nodes of 1.5-2.0 cm in the left cervical region. Laboratory tests were unremarkable, except for an elevated erythrocyte sedimentation rate. Excisional biopsy, radiography, ultrasound, CT scan, bone marrow biopsy, radionuclide imaging, echocardiography and lung function tests. Early-stage unfavorable (intermediate) lymphocyte-rich classical Hodgkin's lymphoma. Chemotherapy (treatment with doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy.