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Clinical Summary

Inflammation of lymphatic channels in subcutaneous tissue is commonly caused by spread of local bacterial infection; group A β-hemolytic streptococcal species are the most frequently implicated. Lymphangitis is characterized by red linear streaks extending, within 24 to 48 hours, from a primary site of infection (eg, abscess, cellulitis) to regional lymph nodes (eg, axilla, groin). The lymph nodes are often enlarged and tender. The differential diagnosis includes cellulitis, trauma, and superficial thrombophlebitis.

Management and Disposition

Rest, elevation, immobilization, and antibiotics are the initial treatment. Coverage for Streptococcus and Staphylococcus is appropriate. Toxic-appearing patients require admission for parenteral antibiotics. Any patient sent home with oral antibiotics should be followed up in 24 to 48 hours. Patients who subsequently do not show improvement require admission for parenteral antibiotic therapy. Consider treatment for CA-MRSA in addition to standard skin coverage in highly endemic areas or in at-risk populations.

Pearls

  1. Consider Pasteurella multocida with cat and dog bites, Spirillum minus with rat bites, and Mycobacterium marinum in association with swimming pools and aquaria.

  2. Chronic lymphangitis may be associated with mycotic, mycobacterial, and filarial infection.

  3. Aspiration of the leading edge is generally not helpful for acute management.

FIGURE 12.17

Lymphangitis. Severe lymphangitis extending from metacarpophalangeal wound up the arm from a “fight bite.” The red streak extends from the hand to the axilla, extending along lymphatic channels. (Photo contributor: Selim Suner, MD, MS.)

FIGURE 12.18

Lymphangitis. The red streak extends from ankle to groin along lymphatic channels. The site of infection was the great toe. (Photo contributor: Liudvikas Jagminas, MD.)

FIGURE 12.19

Lymphangitis. Lymphangitis in the upper extremity, in this case from wrist to upper arm, commonly arises from nail biting. (Photo contributor: R. Jason Thurman, MD.)

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