A 58-year-old woman presented with breast and rib pain. She reported left axillary lymphadenopathy, abdominal fullness, and malaise. She denied fever and breast drainage. Her past medical history was significant for hepatitis C. Socially, she had two cats and was bitten by a cat a month prior. Review of systems was positive for fatigue and negative for appetite change, chills, diaphoresis, and fevers. Lung cancer screening CT, which was completed a day prior to this visit, showed an ill-defined mass measuring up to 3.5 cm in the left axilla. There was mild adjacent soft tissue stranding. These findings indicated an infectious, inflammatory, or malignant process. She was promptly treated with doxycycline for CSD, but also recommended to obtain a diagnostic mammogram and an ultrasound of the left axilla. The imaging showed an enlarged lymph node with an adjacent abscess, which altogether measured 30 x 17 mm in the left axilla (Figure ).\nTherefore, a lymph node biopsy and drainage of the abscess with culture were ordered. The lymph node biopsy revealed necrotizing granulomatous inflammation with the following differential diagnosis: CSD, tuberculosis, and other infectious entities. The abscess culture was negative for aerobic/anaerobic organisms and showed few polymorphonuclear leukocytes. Given her history of a cat scratch, symptoms, and pathology results, an infectious etiology was most likely. To confirm the diagnosis and rule out other causes, serology for B. henselae was ordered which showed high B. henselae IgG titer of >1:1024 and IgM titer of 1:128.
A 25-year-old male patient with no significant past medical history presented with a three-day history of a tender mass in the right axilla along with fevers. The patient did not report any night sweats and weight loss. The mass showed no signs of drainage or infection. His physical examination revealed a 3 x 5 cm mobile, soft and non-nodular mass in the right axilla. An ultrasound of the right axilla showed a fluid-filled mass, which was concerning for an abscess. A needle aspiration was attempted without success; therefore, a referral to breast imaging clinic for a diagnostic ultrasound of the mass was initiated. Targeted ultrasound showed axillary lymphadenopathy at the site of the clinically palpable mass (Figure ). Ultrasound-guided biopsy was performed, and pathology revealed suppurative granulomatous lymphadenitis suggestive of CSD. Serology was not available for this case.