Axillary Mass in Young Woman with History of Hidradenitis Suppurativa
Case at a Glance
A 20-year-old female presents with a newly discovered painless, palpable mass in the left axilla, concerning for either lymphadenopathy or hidradenitis suppurativa flare-up in the context of recent shaving and known history of the condition.
Patient's Story
The patient noticed a hard, painless lump in her left armpit during self-examination. She reports the mass is palpable but not visually apparent. The patient has a known history of hidradenitis suppurativa with recurring cysts and scarring in the genital region over several years. She notes that hair growth appears stunted above the axillary mass, similar to what occurs with her genital lesions. Recent shaving of the axillary area preceded the discovery of the mass. The patient also mentions mild soreness in the left elbow of uncertain relation. She has a family history of breast cancer in her maternal grandmother and experiences health-related anxiety.
Initial Assessment
Physical examination revealed a firm, non-tender mass in the left axilla without obvious inflammatory changes. The mass was palpable but not visible on inspection. No other lymphadenopathy was noted. The patient appeared anxious but otherwise well.
The Diagnostic Journey
Given the patient's history of hidradenitis suppurativa and recent axillary shaving, the differential diagnosis included: 1) Hidradenitis suppurativa flare-up, 2) Reactive lymphadenopathy, 3) Infectious lymphadenitis, 4) Less likely but concerning - malignant lymphadenopathy. The patient's family history of breast cancer and the axillary location warranted careful evaluation.
Final Diagnosis
Clinical assessment favored hidradenitis suppurativa flare-up based on the patient's established history, recent trigger (shaving), and characteristic hair growth pattern changes. However, close monitoring was recommended given the axillary location and family history.
Treatment Plan
Conservative management with warm compresses, avoidance of further shaving irritation, and anti-inflammatory measures. Patient education regarding hidradenitis suppurativa triggers and management. Scheduled follow-up in 2-3 weeks to reassess the lesion.
Outcome and Follow-up
Patient was counseled on monitoring for changes in size, consistency, or development of additional masses. Clear instructions provided for urgent medical attention if the mass enlarged significantly, became painful, or if constitutional symptoms developed. Follow-up appointment scheduled with primary care physician for ongoing hidradenitis suppurativa management and routine screening given family history.