Lymphangitis

Definition and EtiologyTop

Lymphangitis is inflammation of the superficial lymph vessels due to infectious and noninfectious causes. Lymphangitis most commonly develops as a result of skin damage or an abscess.

Etiologic factors are most often group A beta-hemolytic streptococci and staphylococci; lymphangitis may be also caused by other microorganisms in immunocompromised patients (gram-negative bacteria, anaerobes) and result from bite wounds (Pasteurella multocida). In endemic areas (mainly Southeast Asia), lymphangitis is most frequently caused by nematodes (filariasis). In some cases malignancies can also cause lymphangitis, which is sometimes referred to as neoplastic lymphangitis; breast, prostate, stomach, lung, pancreas, colon, and rectal cancers can be the cause.

Clinical FeaturesTop

Lymphangitis may cause fever, chills, and irregular, linear skin erythema spreading from the site of infection towards regional lymph nodes, which may be enlarged and painful. If left untreated, lymphangitis may lead to lymphadenitis and sepsis.

DiagnosisTop

Diagnosis is based on clinical manifestations. Lymphangitis needs to be differentiated from superficial phlebitis and contact dermatitis. Laboratory tests (eg, swab, Gram staining, culture, microscopy, serology) may be helpful in finding specific organisms and choosing antimicrobial therapies in cases of infectious lymphangitis.

TreatmentTop

Antimicrobial treatment, often empiric, usually involving beta-lactamase–resistant penicillins (eg, cloxacillin), penicillins with beta-lactamase inhibitors, or second- or third-generation cephalosporins administered orally.

ComplicationsTop

Sepsis, lymph node abscesses, lymphedema (especially in patients with recurrent lymphangitis).