Case of Chronic Hepatitis C Presenting with Right Axillary Lymphadenopathy

Abstract

Purpose: Chronic hepatitis C is the most common cause of chronic liver disease. Most patients with chronic infection are usually asymptomatic or have mild nonspecific symptoms such as fatigue, myalgias, arthralgias, weakness, and weight loss. Extrahepatic manifestations have been associated with chronic hepatitis C infection. We present an unusual case of a patient with hepatitis C presenting with right axillary lymphadenopathy. Case Presentation: This is a 52 year old African-American male with history of hepatic C who noticed an enlarging mass under his right armpit for 2 1/2 months. He reports no night sweats, fevers, fatigue or weight loss. He denied any abdominal pain and review of system was otherwise negative. Physical exam was notable for 6 cm area of adenopathy in his right axilla. All other areas including supraclavicular, cervical, groin and left axillary were negative for adenopathy. Abdominal exam was nontender without hepatosplenomegaly. Liver enzymes including AST, ALT, Alk Phos were normal. The right axillary lymph node was excised. Pathology revealed florid follicular hyperplasia (Fig. 1). There was no evidence of Reed-Sternberg cells or variants. Immunostain for hepatitis C virus showed multiple foci of scattered positive intranuclear staining of macrophages and lymphocytes. The final diagnosis was florid reactive follicular hyperplasia associated with hepatitis C viral infection. Conclusion: To our knowledge, this is the first case of a patient with chronic hepatitis C presenting with right axillary adenopathy associated with the disease.