A 43-year-old man comes to the office because of a 2-week history of fatigue and mild pain in his right armpit. He has not had fever or weight loss. Medical history is remarkable for type 2 diabetes mellitus and hypercholesterolemia. Medications are metformin, simvastatin, and aspirin. He is a social worker and frequently visits clients in homeless shelters. He lives alone with two dogs and a cat and has one male sexual partner. Vital signs are within normal limits. He appears well. Examination of the right upper extremity shows an erythematous axilla with a 4-cm, mobile, tender, nonfluctuant axillary lymph node and a tender, 1-cm epitrochlear lymph node. Abdominal examination shows no hepatosplenomegaly.
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