Nodular lymphangitis: Report of a case with presentation of a diagnostic paradigm

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 pa...

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Bibliographic Details
Published in:Dermatology online journal 2010-09, Vol.16 (9), p.1-1
Main Authors: Giordano, Cerrene Nicole, Kalb, Robert E, Brass, Corstiaan, Lin, Lin, Helm, Thomas N
Format: Article
Language:English
Subjects:
Arm
Diagnosis, Differential
Hand
Humans
Leishmania
Lymphangitis - microbiology
Male
Middle Aged
Mycobacterium avium Complex
Mycobacterium Infections, Nontuberculous - diagnosis
Mycobacterium Infections, Nontuberculous - drug therapy
Mycobacterium marinum - isolation & purification
Nocardia
Skin Diseases, Bacterial - diagnosis
Skin Diseases, Bacterial - drug therapy
Sporothrix
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Summary: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.
ISSN:1087-2108
1087-2108
DOI:10.5070/D342F9H4SK