Persistent Left Supraclavicular Lymphadenopathy with Systemic Symptoms in a Young Adult

Case at a Glance

A 24-year-old female presents with a 3-year history of progressive left supraclavicular lymphadenopathy accompanied by constitutional symptoms including night sweats, heat intolerance, polyuria, polydipsia, and cognitive impairment.

Patient's Story

The patient is a 24-year-old female, height 5'2", weight 126 lbs, with a 7-year history of vaping. Current medications include oral contraceptives, minoxidil, and hydroxyzine as needed. She reports a 3-year history of a progressively enlarging left supraclavicular lymph node that is round, painless, and firm to palpation. An additional left cervical lymph node has demonstrated fluctuating size over the same period. Laboratory findings reveal low CO2 and sodium levels.

Initial Assessment

The patient presents with concerning constitutional symptoms including excessive thirst, frequent urination (nocturia 3-5 times per night), night sweats, heat intolerance requiring ambient temperature of 67°F for comfort, and cognitive symptoms including memory impairment and brain fog. Additional symptoms include retrosternal back pain, occasional burning sensations in the lower back, frequent lightheadedness, and gastrointestinal complaints.

The Diagnostic Journey

The patient's presentation of a persistent, hard, painless left supraclavicular lymph node (Virchow's node) combined with constitutional symptoms raised immediate concern for malignancy, particularly lymphoma or metastatic disease. The constellation of symptoms including night sweats, heat intolerance, cognitive changes, and polyuria/polydipsia suggested systemic involvement requiring urgent evaluation.

Final Diagnosis

The case presentation is highly suggestive of hematologic malignancy, most likely lymphoma, given the classic presentation of Virchow's node with B-symptoms (night sweats, heat intolerance) and systemic manifestations.

Treatment Plan

Immediate referral for urgent hematology-oncology consultation. Recommended diagnostic workup includes: CT imaging of chest, abdomen, and pelvis; comprehensive metabolic panel; complete blood count with differential; lactate dehydrogenase; ESR/CRP; and tissue biopsy of the supraclavicular lymph node for definitive diagnosis. Given the concerning presentation, evaluation should not be delayed.

Outcome and Follow-up

Patient was advised to seek immediate medical attention rather than waiting for scheduled appointment due to the urgent nature of her presentation. The combination of persistent supraclavicular lymphadenopathy with constitutional symptoms requires prompt evaluation to rule out malignancy and initiate appropriate treatment if indicated.