Superficial Lymphangitis after Arthropod Bite: A Distinctive but Underrecognized Entity?

Abstract

Background: Acute bacterial lymphangitis is a common occurrence after skin damage. This diagnosis is often made in case of red linear streaks after arthropod bites, leading to the prescription of oral antibiotics. In this setting, noninfectious superficial lymphangitis after arthropod bites, an eruption rarely mentioned in the medical literature, appears as a diagnostic challenge. Objective: Our purpose was to study the clinical and histopathological features of this underrecognized condition. Methods: We collected the observations of six consecutive patients seen between the years 2003 and 2006, who developed an acute linear erythematous eruption along lymphatic vessels, mimicking common bacterial lymphangitis. Standard histological examinations were completed by immunopathological staining using the monoclonal antibody D2-40, a highly selective marker of lymphatic endothelium. Extensive review of the literature about acute noninfectious superficial lymphangitis was performed. Results: The clinical presentation and histological findings excluded an infectious etiology and suggested superficial lymphangitis after an arthropod bite in all the observations. Conclusions: This article analyzes the clinical and histological features of noninfectious superficial lymphangitis after arthropod bite, a benign underrecognized condition mimicking common bacterial lymphangitis. Physicians should be aware of this benign reaction to avoid the useless prescription of antibiotics.

Nonbacterial Causes of Lymphangitis with Streaking

“…2,18 -22 In general, lymphangitic streaking associated with an insect bite has not been reported to present with systemic systems or LAD. 2,18,20,21 The mechanism of lymphangitis is proposed to be secondary to either a hypersensitivity reaction or toxin injection. 2,18,23,24 Certain patient populations, such as those with hematologic abnormalities, have a greater tendency to develop exaggerated responses after arthropod bites.…”

“…2,18,20,21 The mechanism of lymphangitis is proposed to be secondary to either a hypersensitivity reaction or toxin injection. 2,18,23,24 Certain patient populations, such as those with hematologic abnormalities, have a greater tendency to develop exaggerated responses after arthropod bites. For instance, it has been well described that patients with chronic lymphocytic leukemia tend to develop exaggerated responses to arthropod bites, which manifest as vesicles or bullae with prominent edema and erythema that may be accompanied by lymphadenopathy and lymphangitic streaking [25][26][27] (Figure 2).…”

“…Lymphangitic streaking is most often described in association with acute bacterial infections, such as Staphylococcus aureus, Streptococcus pyogenes, and Pasteurella multocida infections. 1,2 Consequently, the presence of lymphangitic streaking often leads clinicians to treat patients with systemic antibiotics. 2 However, superficial lymphangitis may also occur as a result of a variety of other nonbacterial etiologies, such as viral or fungal infections, arthropods bites, or iatrogenic interventions (Table 1).…”

Recurrent superficial lymphangitis after insect bites

“…Superficial lymphangitis after insect bite is an underestimated entity mimicking acute bacterial lymphangitis 1. Only a few cases have been described so far 1–4.…”

“…In contrast to infection, the site of insect bites from which lymphangitis emanates is pruritic and not painful or tender 5. Other characteristic features are the absence of fever and lymph node enlargement and a rapid spontaneous regression 1. The highest intensity of the linear erythema is at the site of insect bites 5.…”