Persistent Inguinal Lymphadenopathy in a Young Adult Male

Case at a Glance

A 21-year-old male presents with a 3-week history of a hard, painless lymph node in the right inguinal region, concerning for possible lymphoproliferative disorder given characteristics and previous similar presentation.

Patient's Story

The patient first noticed a hard, small nodule in his right inguinal crease on June 10th. He describes it as completely painless but easily palpable, approximately 2cm in size with an oval shape. The mass moves with the overlying skin when manipulated. He reports a similar episode in September 2023 involving his left axillary region, which resolved spontaneously after 1-1.5 months but left residual hyperpigmentation. The patient expresses significant anxiety about potential malignancy, particularly lymphoma, given the characteristics of the mass.

Initial Assessment

Physical examination reveals a firm, non-tender, mobile mass in the right inguinal region measuring approximately 2cm. The patient appears anxious but otherwise well. Vital signs are stable. He reports intermittent sleep disturbances, occasional pruritus of the chest, and stable weight despite good appetite. Social history is significant for nicotine vaping but denies alcohol or illicit drug use.

The Diagnostic Journey

Given the patient's concerns about lymphoma and the characteristics of the lymphadenopathy, initial workup included complete blood count, comprehensive metabolic panel, and lactate dehydrogenase levels. The patient's history of similar self-resolving lymphadenopathy with residual pigmentation was noted. Differential diagnosis included reactive lymphadenopathy, infectious causes, cystic lesions, and lymphoproliferative disorders.

Final Diagnosis

Reactive inguinal lymphadenopathy, likely secondary to minor local irritation or subclinical infection. The clinical presentation and benign characteristics favor a reactive process rather than malignancy.

Treatment Plan

Conservative management with close observation was recommended. Patient education was provided regarding normal lymph node function and when to seek immediate care. Follow-up appointment scheduled in 4-6 weeks to reassess the lymph node. Patient advised to monitor for any changes in size, consistency, or development of systemic symptoms.

Outcome and Follow-up

Patient was reassured about the likely benign nature of his condition while maintaining appropriate vigilance. He was counseled on smoking cessation resources given his nicotine use. Instructions provided to return immediately if the mass enlarges significantly, becomes painful, or if constitutional symptoms develop.