Peer Reviewed
Chronic Bilateral Axillary Lesions in a 16-Year-Old Male
A 16-year-old male with no past medical history presented to the emergency room with 6 months of worsening axillary lesions. He had a 2-year history of intermittent swollen, painful lesions in his bilateral axilla that would occasionally drain a thin white fluid. His range of motion at the shoulder had also progressively become more limited. A recent course of oral doxycycline did not improve his symptoms. He had no recent travel. His family recently adopted a kitten that had not been vaccinated. He had had no fever, weight loss, vomiting, or diarrhea.
On presentation, the patient appeared alert and oriented, but shy. He had a reassuring physical exam except for his axilla, which contained 2 to 3 deep sinus tracts draining cloudy fluid. On the left axilla, the patient had a 1 × 2 cm tender nodule. No erythema, induration, or fluctuance was noted. He had no lesions elsewhere on his body. He was unable to abduct his shoulders more than 90°. His vital signs were within normal limits.
Initial lab results showed normal complete blood count (CBC), C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR). A wound culture was obtained that had moderate growth of mixed cutaneous flora.
What could be causing this patent’s lesions?
- Cat scratch fever
- Furunculosis
- Hidradenitis suppurativa
- Cutaneous manifestation of Crohn disease
Answer on next page.