lymphangitis

The classic presentation is a patient with cellulitis or a puncture wound of the hand or foot who develops linear erythematous streaks extending up the limb, with tender regional lymphadenopathy and often fever and rigors. Group A Streptococcus is the usual organism, with Staphylococcus aureus next; Pasteurella multocida should be considered after a cat or dog bite because of its rapid onset within twenty-four hours, and Erysipelothrix after fish or meat handling. Treatment is prompt systemic antibiotics with limb elevation, since untreated lymphangitis can progress to bacteraemia. Nodular lymphangitis, in which discrete nodules rather than a continuous streak ascend the limb, is the sporotrichoid pattern and suggests Sporothrix schenckii, Mycobacterium marinum, Nocardia brasiliensis, or Leishmania. Chronic lymphangitis with obstruction leads to lymphoedema, the extreme being elephantiasis from Wuchereria bancrofti. Non-infectious lymphangitic spread of carcinoma, lymphangitic carcinomatosis, produces septal thickening on chest imaging and progressive dyspnoea.