Nodular lymphangitis: A distinctive clinical entity with finite etiologies

Abstract

Nodular lymphangitis, characterized by inflammatory nodules along the lymphatics draining a primary skin infection, most commonly follows superficial inoculation with Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, Leishmania (Viannia) panamensis/guyanensis, and Francisella tularensis. Epidemiologic context, clinical presentation, and presumed incubation period help to predict the specific etiologic microorganism. Sporotrichosis, often occurring in gardeners, remains the most recognized cause of nodular lymphangitis. Injuries sustained in marine environments suggest Mycobacterium marinum infection. An incubation time of 1 to 5 days, a painful chancre at the initial lesion site, and prominent tender lymphadenitis strongly implicate tularemia. Frankly purulent discharge from the primary lesion is associated with some infections due to Francisella and Nocardia species. Lesions failing to respond to empirical treatment should usually be biopsied. A detailed history and clues from the physical examination, supplemented by biopsy specimens in selected circumstances, should allow specific therapy for most patients.

Sporothrix schenckii and Sporotrichosis

“…Apart from cutaneous leishmaniasis, other causes, including noninfectious skin ulcers, should be considered. In the lymphocutaneous form, other disorders that present nodular lymphangitis should be investigated (58,253), particularly mycobacteriosis. Among the mycobacteria, Mycobacterium marinum infection often accompanies lymphocutaneous lesions.…”

Erythematous Subcutaneous Nodules in a Neonate

“…Lesions commonly follow superficial inoculation with Sporothrix schenckii , Nocardia brasiliensis , Mycobacterium marinum , Leishmania panamensis/guyanensis , or Francisella tularensis and usually occur on the upper or lower extremities. Microbial etiologies can often be differentiated on the basis of detailed history, geographic distribution, mode of acquisition, and clinical features . Biopsy of a lesion for histology, routine stains (Gram, silver, periodic acid–Schiff), and cultures (fungi, mycobacteria, viruses, bacteria) are indicated and can direct specific therapy for each patient .…”

“…Microbial etiologies can often be differentiated on the basis of detailed history, geographic distribution, mode of acquisition, and clinical features . Biopsy of a lesion for histology, routine stains (Gram, silver, periodic acid–Schiff), and cultures (fungi, mycobacteria, viruses, bacteria) are indicated and can direct specific therapy for each patient .…”

Esporotricosis y cromoblastomicosis: revisión de la literatura

“…También se debe pensar en nocardiosis (producida por Nocardia brasiliensis), cromoblastomicosis, criptococosis, blastomicosis y enfermedad por arañazo de gato (25,26). En la forma fija el principal diagnóstico diferencial es la leishmaniasis cutánea, aunque también se deben considerar úlceras de causa no infecciosa (3,5).…”