Description

Acute or chronic inflammation of lymphatic channels that typically presents as red, tender streaks extending (often quickly) to regional lymph nodes

• May be infectious or noninfectious
• Commonly occurs on an extremity secondary to a skin infection that extends into the lymphatic vessels
• May result from compromised lymphatic drainage following surgical procedures, trauma, or malignancy

Etiology and Pathophysiology

• Acute infection
  • Usually caused by group A β-hemolytic Streptococcus
  • Immunocompromised patients often infected with gram-negative bacteria or fungi; usually secondary to lower extremity cellulitis
  • Less commonly caused by:
    • Staphylococcus aureus
    • Pasteurella multocida
    • Erysipelothrix (fish exposure)
    • Spirillum minus (rat bite disease)
    • Pseudomonas
    • Other Streptococcus sp.
    • In fresh water exposures, Aeromonas hydrophila
    • Bacillus anthracis
    • Parapoxvirus (occupational milker’s nodule)
    • Herpes simplex virus (lymphogranuloma venereum)
• Nodular lymphangitis
  • Also known as sporotrichoid lymphangitis
  • Painful or painless nodular subcutaneous swellings along lymphatic vessels
  • Lesions may ulcerate with accompanying regional lymphadenopathy.
  • Usually does not develop as rapidly as acute lymphangitis and may not present with systemic symptoms
  • Typical of infections from Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, Leishmania sp., Francisella tularensis, 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; less commonly, 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)
  • Associated cancers include breast, lung, stomach, pancreas, and rectal.
• 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 processes.
• 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)