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Lymphangitis

Lymphangitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Acute or chronic inflammation of lymphatic channels due to a skin breach or local trauma; presents as red, tender streaks along lymphatic channels extending to regional lymph nodes

  • May result from compromised lymphatic drainage following surgical procedures
  • May be infectious or noninfectious

Etiology and Pathophysiology

  • Acute infection
    • Usually caused by group A β-hemolytic Streptococcus
    • Less commonly caused by:
      • Staphylococcus aureus
      • Pasteurella multocida
      • Erysipelothrix
      • Spirillum minus (rat bite disease)
      • Pseudomonas
      • Other Streptococcus sp.
      • Immunocompromised patients can be infected with gram-negative rods, gram-negative bacilli, or fungi.
      • In fresh water exposures, Aeromonas hydrophila
  • Nodular lymphangitis
    • Also known as sporotrichoid lymphangitis
    • Painful or painless nodular subcutaneous swellings along lymphatic vessels
    • Lesions may ulcerate with accompanying regional lymphadenopathy.
    • Typical of infections from: Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, leishmaniasis, tularemia, and systemic mycoses
    • Pathology may show granulomas.
  • Noninfectious granulomatous lymphangitis
    • Rare-acquired lymphedema of the genitalia in children
    • May be due to atypical Crohn disease or sarcoidosis (1)[C]
  • Filarial lymphangitis
    • Mosquito bites transmit parasites causing lymphatic inflammation and dilatation; can predispose to secondary bacterial infection
    • Usually caused by nematodes Wuchereria bancrofti. Other causes include Brugia malayi and Brugia timori.
  • Lymphangitis can occur after surgical procedures and lymph node dissection.
  • Cutaneous lymphangitis carcinomatosa is rare. Represents ~5% of all skin metastases; caused by neoplastic occlusion of dermal lymphatic vessels (2)
  • Sclerosing lymphangitis of the penis
    • Swelling around coronal sulcus of penis as a result of vigorous sexual activity or masturbation

Risk Factors

  • Impaired lymphatic drainage due to surgery, nodal dissection, or irradiation
  • Diabetes mellitus
  • Chronic steroid use
  • Peripheral venous catheter
  • Varicella infection
  • Immunocompromising condition
  • Human, animal, or insect bites; skin trauma
  • Fungal, bacterial, or mycobacterial skin infections
  • IV drug abuse
  • Residence in endemic areas of filariasis

General Prevention

  • Reduce chronic lymphedema with compression devices or by treating underlying process.
  • Insect repellant; arthropod bite precautions
  • Proper wound and skin care

Commonly Associated Conditions

  • Lymphedema
  • Prior lymph node dissection
  • Tinea pedis (athlete’s foot)
  • Sporotrichosis
  • Cellulitis, erysipelas
  • Filarial infection (W. bancrofti)

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Citation

Stephens, Mark B., et al., editors. "Lymphangitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116842/all/Lymphangitis.
Lymphangitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116842/all/Lymphangitis. Accessed April 18, 2019.
Lymphangitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116842/all/Lymphangitis
Lymphangitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116842/all/Lymphangitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lymphangitis ID - 116842 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116842/all/Lymphangitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -