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

BACKGROUND

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.

INVESTIGATIONS: Excisional biopsy, radiography, ultrasound, CT scan, bone marrow biopsy, radionuclide imaging, echocardiography and lung function tests.

DIAGNOSIS: Early-stage unfavorable (intermediate) lymphocyte-rich classical Hodgkin's lymphoma.

MANAGEMENT: Chemotherapy (treatment with doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy.