Adolescent Patient with Bilateral Axillary Lymphadenopathy and Health Anxiety

Case at a Glance

A 14-year-old male presents with bilateral axillary lymphadenopathy following a recent illness, accompanied by significant health anxiety and frequent self-examination of the nodes.

Patient's Story

The patient initially noticed a lymph node in his right axilla approximately 2-3 weeks ago, which he estimated to be 1-2 cm in size. He reports that this node has subsequently decreased in size to approximately 0.3-0.5 cm. Recently, he discovered a new lymph node in his left axilla, which he believes is also shrinking. The patient experienced an illness approximately 2 weeks prior to presentation. He expresses significant anxiety about these findings and admits to checking the lymph nodes hourly. The patient is reluctant to inform his mother or seek medical attention due to fear of causing worry.

Initial Assessment

Physical examination would likely reveal small, mobile axillary lymph nodes bilaterally. The patient demonstrates signs of health anxiety with obsessive checking behaviors and excessive internet research. Recent illness history suggests reactive lymphadenopathy. The patient appears otherwise healthy with no constitutional symptoms reported.

The Diagnostic Journey

The clinical presentation is consistent with reactive lymphadenopathy following a recent viral illness. The bilateral nature, size reduction over time, and temporal relationship to recent illness support a benign etiology. The patient's anxiety symptoms require concurrent evaluation and management.

Final Diagnosis

1. Reactive bilateral axillary lymphadenopathy, likely post-viral
2. Health anxiety disorder with obsessive checking behaviors

Treatment Plan

1. Reassurance regarding the benign nature of reactive lymph nodes following illness
2. Education about normal lymph node function and response to infection
3. Behavioral counseling to discourage frequent palpation of lymph nodes
4. Referral to mental health services for anxiety management
5. Recommendation to avoid excessive internet searching and social media content related to health concerns
6. Follow-up with primary care physician if nodes persist beyond 4-6 weeks or increase in size

Outcome and Follow-up

Patient education regarding normal lymph node physiology and the importance of mental health support for anxiety management. Long-term outcome depends on adherence to anxiety treatment recommendations and development of healthy coping mechanisms. Regular pediatric follow-up advised for ongoing health maintenance and anxiety monitoring.