A 79-year old female without comorbidities present to my off | Figure 1

BorisJ87

Infectious Diseases

A 79-year old female without comorbidities present to my office with 15-day history of swelling on the right side of the neck, just below angle of mandible. The swelling was not painful and she didn't have a fever. The laboratory done by family doctor showed no abnormalities, and ENT prescribed her a course of amoxicillin/clavulanate. She also did US of the neck which showed hypoechogenic, heterogenic, clearly demarcated, poorly vascularised formation, 27,05 x 17,46 mm in diameter which correspond to enlarged, pathologicaly changed lymph node. After antibiotic therapy, her swelling slightly receded. She was referred to my office. On exam, I noticed two formations on the right side of the neck, one small, and one big, up to 25 mm x 20 mm, which is very hard to touch, slightly painful, and not easily movable on its basis. Also, I noticed this skin change under her right breast which she didn't know about (see images). The rest of exam was unremarkable. Her history is only positive for left mastectomy 27 years ago, because of tumor. She has regular follow-ups for 25 years.

In this case, I am particularly interested in this skin lesion. It reminds me of erythema annulare centrifugum which can be paraneoplastic in nature, but I am not sure, and I would like to hear others' opinions.

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