Lymphangitis

Definition and EtiologyTop

Lymphangitis is an infectious or noninfectious inflammation of the superficial lymph vessels developing as a result skin damage.

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). It can be also caused by malignancies, which is sometimes referred to as neoplastic lymphangitis. Breast, prostate, stomach, lung, pancreas, colon, and rectal cancers can be the cause. Other rare causes of lymphangitis include arthropod bites (especially spider and scorpion), topical medications such as cantharidin, IV catheters, and vaccinations.

Clinical FeaturesTop

Lymphangitis is characterized by irregular linear erythematous cutaneous streaks spreading from the site of inflammation towards regional lymph nodes, which may be enlarged and painful. Lymphangitis can sometimes be associated with localized tenderness, fever, and chills. If left untreated, lymphangitis may lead to lymphadenitis and sepsis.

DiagnosisTop

Diagnosis is based on clinical manifestations. Lymphangitis needs to be differentiated from superficial thrombophlebitis 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

When infectious etiology is the most likely cause, the antibiotic choices, usually given for 7 to 10 days, may include cloxacillin 500 mg qid, penicillins with beta-lactamase inhibitors (eg, amoxicillin/clavulanic acid 875 mg/125 mg orally bid or 500 mg/125 mg orally tid), cefalexin 500 mg qid or 1 g bid.

ComplicationsTop

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