Lymphangitis
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Basics
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
- 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)
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Basics
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
- 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)
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