Lymphadenitis “As Rosary beads” - a diagnostic challenge

Abstract

Introduction: nodular lymphangitis (NL) may be a manifestation of various infectious and non-infectious conditions, characterised by subcutaneous inflammatory nodules that extend from the site of the primary focus to the regional lymph nodes. NL usually constitutes a challenge in primary health care, and histopathological and microbiological evaluations are necessary to establish the definitive diagnosis. Methods: We report a classic case of NL that developed in the upper limb of a middle-aged man after trauma on the right thumb. The objective: was to emphasise some aspects of the differential diagnosis in a patient with NL and to reduce the rate of misdiagnosis in the scenery of initial medical attention. Results: the clinical manifestations were non-specific, but the microbiological study revealed typical characteristics of sporotrichosis. The treatment with itraconazole (200 mg daily) for six months was successful. Conclusion: NL constitutes a challenging condition and the early diagnosis depends on a high index of suspicion. Case reports may reduce late diagnoses with unfavourable results.