Nodular lymphangitis: Report of a case with presentation of
a diagnostic paradigm.
Sept 2010
Source
University at Buffalo School
of Medicine and Biomedical Sciences, USA
Abstract
A 54-year-old man with
asthma, mitral valve prolapse, and a back injury developed erythematous nodules
that progressed along the lymphatic drainage of his right arm. Skin biopsy
revealed granulomatous inflammation with microabscess formation. Culture
confirmed Mycobacterium marinum infection.
The patient was treated with clarithromycin,
ethambutol, rifampin, and topical silver sulfadiazine. Oral doxycycline hyclate
was later added because of slow healing. Mycobacterium marinum is one of a
group of infectious agents that can cause nodular lymphangitis. Sporotrichoid lesions most commonly
develop after cutaneous inoculation with Sporothrix schenckii, Leishmania
species, Nocardia species, and Mycobacterium marinum.
A thorough clinical
history and physical examination can narrow the differential diagnosis by
eliciting information about the etiologic setting, incubation time, clinical
appearance of the lesions, and presence or absence of systemic involvement for
each of the causative organisms. Skin biopsy and microbiological tissue
cultures are essential for diagnostic confirmation. The differential diagnosis
and a suggested diagnostic paradigm will be reviewed.
