Virginia Research Day 2025

Medical Resident Research Case Reports

03 From Game Day to Cat Play: A Curious Lump in a Division 1 Football Player

Elizabeth Walker, DO; Kalina Buckenmyer, OMSII; Alex Black, ATC; Claudia Putman, ATC; Brett Griesemer, ATC; Jerome Goldschmidt, Jr, MD; Matthew Chung, DO; Mark Rogers, DO. Corresponding author: ewalker01@vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus Virginia Tech University, Blacksburg, VA

A Division 1 Football player presented to the clinic after practice complaining of a painful lump in his right axilla, as well as two additional lumps just proximal to his elbow. He first noticed the lumps about ten days prior, when he was evaluated for increased burping and abdominal gas pains. Further discussion with his parents and coaches revealed recent fatigue and a bout of night sweats prior to the first game of the season. He denied fevers, chills, cough, nausea, vomiting, constipation, or diarrhea. He was very concerned due to his family history of lymphoma. Physical exam revealed a well-appearing young male, who did not appear acutely ill. There were two firm, erythematous lesions on the medial aspect of the distal upper arm measuring 4x4cm and 6x7cm. Additional 5x5cm fluctuant mass was noted on the Right axilla. Abdominal exam was benign. POCUS revealed an oval-shaped hypoechoic region measuring approximately 3.5 cm in diameter with a hyperechoic layer surrounding the space and a hyperechoic septum separating the suspected area in two.

Differential diagnoses: Lymphoma, infectious lymphadenopathy, cyst, benign adenoma, hidradenitis suppurativa Additional testing: CBC is grossly normal, CMP with mildly elevated AST at 46. Negative CMV IgG & IgM. Positive EBV IgG, negative IgM. Sed rate & CRP elevated at 10 and 25, respectively. LDH elevated at 265. CT Upper extremity revealed multiple R axillary lymph nodes, the largest measuring 40 x 29 mm. An additional epitrochlear lymph node was identified and measured 37 x 25 mm. CT Abdomen revealed enlarged spleen 15.6 x 6.3 cm, with lymph node just medial to the stomach, measuring 21 mm. Abdominal US was obtained to characterize the splenomegaly; revealed enlarged liver at 23.9 cm and spleen 13.8 cm. Ultrasound guided core needle biopsy of the right axillary node revealed lymphoid tissue with necrotizing caseating granulomatous inflammation. Negative for malignancy.

The athlete was referred to Hematology & Infectious Disease who requested additional labs: negative Lyme titers, HIV, RPR & Rickettsia. Positive Bartonella Henselae IgG, negative IgM. Final diagnoses : Infectious Lymphadenopathy secondary to Bartonella Henselae, with hepatosplenomegaly Follow up and Return to Play: He was treated with Azithromycin, however given his hepatosplenomegaly, he was held out of sport while undergoing further eval and treatment. Abdominal ultrasounds were performed biweekly to monitor progress. Approximately 6 weeks after the initial presentation, his spleen & liver sizes were relatively unchanged on ultrasound. Hematology & Infectious Disease recommended non-contact activity until the spleen is < 13 cm and liver < 16 cm. The athlete noted a decrease in fatigue and size of his lymph nodes and began to slowly incorporate cardio and non-contact exercises. At 8 weeks, the size of his liver and spleen were deemed stable and he was cleared to return to contact play with extra padding and protection. He will have a postseason abdominal ultrasound for continued monitoring. The authors of this case received patient consent to use their information.

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