Nodular lymphangitis: Difference between revisions

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* Characterized by purulent nodules appearing along the course of reqional lymphatics
*Characterized by purulent nodules appearing along the course of regional lymphatics


== Differential Diagnosis ==
==Differential Diagnosis==
=== Most common ===
===Common===
{| class="wikitable"
{| class="wikitable"
! Organism
!Organism
! Distribution
!Distribution
! Exposures
!Exposures
! Incubation
!Incubation
! Initial presentation
!Initial presentation
|-
|-
| [[Sporothrix schenckii]]
|[[Sporothrix schenckii]]
| South and Central America and southern North America
|South and Central America and southern North America
| gardening (especially roses), other soil contact, animal scratches or bites
|gardening (especially roses), other soil contact, animal scratches or bites
| 1 week to 3 months
|1 week to 3 months
| painless ulcerated nodule
|painless ulcerated nodule
|-
|-
| [[Mycobacterium marinum]]
|[[Mycobacterium marinum]]
| worldwide
|worldwide
| fish and acquiraiums, including falt- and freshwater exposures
|fish and aquariums, including salt- and freshwater exposures
| 1 to 6 weeks
|1 to 6 weeks
| mildly tender, ulcerated nodule
|mildly tender, ulcerated nodule
|-
|-
| [[Nocardia brasiliensis]]
|[[Nocardia brasiliensis]]
| worldwide
|worldwide
| soil, cat scratch
|soil, cat scratch
| 3 days to 6 weeks
|3 days to 6 weeks
| tender, ulcerated, draining nodules
|tender, ulcerated, draining nodules
|-
|-
| [[Leishmania brasiliensis]]
|[[Leishmania brasiliensis]]
| South and Central America
|South and Central America
| sand flies
|sand flies
| 2 to 24 weeks
|2 to 24 weeks
| painless, punched-out shallow ulcer
|painless, punched-out shallow ulcer
|-
|-
| [[Francisella tularensis]]
|[[Francisella tularensis]]
| North America
|North America
| wild animal exposures (especially hunting) or ticks
|wild animal exposures (especially hunting) or ticks
| 1 to 6 days
|1 to 6 days
| painful ulcerated draining papule
|painful ulcerated draining papule
|-
|-
| [[Bacillus anthracis]]
|[[Bacillus anthracis]]
| worldwide
|worldwide
| animal, animal product, or contaminated soil exposures
|animal, animal product, or contaminated soil exposures
|
| painless ulcer with vesicles and edema
|painless ulcer with vesicles and edema
|-
|-
| [[Staphylococcus aureus]]
|[[Staphylococcus aureus]]
| worldwide
|worldwide
|
|
| 4 to 10 days
|4 to 10 days
| abscesses, with or without drainage
|abscesses, with or without drainage
|-
|-
| [[Coccidioides species]]
|[[Coccidioides immitis]]
| Southwest US and northern Mexico
|Southwest US and northern Mexico
| soil exposure or laboratory exposure
|soil exposure or laboratory exposure
| 1 to 4 weeks
|1 to 4 weeks
| verrucous plaques and ulcerated nodules
|verrucous plaques and ulcerated nodules
|-
|-
| [[Blastomyces dermatitidis]]
|[[Blastomyces dermatitidis]]
| worldwide, particularly North America
|worldwide, particularly North America
| soil, animal bites or scratches, laboratory exposure
|soil, animal bites or scratches, laboratory exposure
| 1 to 5 weeks
|1 to 5 weeks
| verrucous plaques and ulcerated nodules
|verrucous plaques and ulcerated nodules
|-
|-
| [[Histoplasma capsulatum]]
|[[Histoplasma capsulatum]]
| worldwide
|worldwide
| soil, birds, laboratory exposure
|soil, birds, laboratory exposure
|5 to 18 days
| myriad
|myriad
|-
|-
| [[Scedosporium species]]
|[[Scedosporium]]
| worldwide
|worldwide
| soil, water, or seage
|soil, water, or sewage
|
|
| nodules
|nodules
|-
|-
| [[Herpes simplex virus]]
|[[Herpes simplex virus]]
| worldwide
|worldwide
|
|
| 2 to 12 days
|2 to 12 days
| vesicles
|vesicles
|-
|-
| [[Vaccinia virus]]
|[[Vaccinia virus]]
|
|
| cattle and cats
|cattle and cats
|
|
|
|
|}
|}


=== Full list ===
===Exhaustive List===

* Fungi
*'''Fungi'''
** [[Sporothrix schenckii]]
**[[Sporothrix schenckii]]: gardening or dirt exposure
** [[Blastomyces dermatitidis]]
** [[Coccidioides immitis]]
**[[Blastomyces dermatitidis]]
** [[Histoplasma capsulatum]]
**[[Coccidioides immitis]]
** [[Cryptococcus neoformans]]
**[[Histoplasma capsulatum]]
** [[Scedosporium apiospermum]]
**[[Cryptococcus neoformans]]
** [[Fusarium species]]
**[[Scedosporium apiospermum]]
** [[Scopulariopsis blochii]]
**[[Fusarium]]
** [[Eumycotic mycetoma]]
**[[Scopulariopsis blochii]]
**[[Eumycotic mycetoma]]
** [[Rhinocladiella aquaspersa]] ([[chromoblastomycosis]])
**[[Rhinocladiella aquaspersa]] ([[chromoblastomycosis]])
* Bacteria
*'''Bacteria'''
** [[Norcardia]] species, including [[N. brasiliensis]], [[N. asteroides]], [[N. otidiscaviarum]], and [[N. transcalensis]]
**[[Norcardia]] species, including [[N. brasiliensis]], [[N. asteroides]], [[N. otidiscaviarum]], and [[N. transcalensis]]: soil or water exposure
** ''[[Mycobacterium marinarum]]'', [[Mycobacterium chelonei]], and [[Mycobacterium fortuitum]], and rarely [[Mycobacterium kansasii]]
**[[Mycobacterium tuberculosis]] (tuberculosis cutis verrucosa)
⚫
** ''[[Francisella tularensis]]'' (ulceroglandular tularemia)
**[[Non-tuberculous mycobacteria]]
⚫
** [[Burkholderia pseudomallei]] (melioidosis)
***''[[Mycobacterium marinum]]'': saltwater or marine exposure
** [[Staphylococcus aureus]]
** [[Streptococcus pyogenes]]
***''[[Mycobacterium chelonei]]''
***''[[Mycobacterium fortuitum]]''
⚫
** [[Bacillus anthracis]] (cutaneous anthrax)
***Rarely ''[[Mycobacterium kansasii]]''
⚫
** [[Erysipelothrix rhusiopathiae]]
⚫
**''[[Francisella tularensis]]'' (ulceroglandular tularemia): excrutiatingly painful; hunting; deer flies and ticks
⚫
* Viruses
⚫
**[[Burkholderia pseudomallei]] (melioidosis)
⚫
** [[Vaccinia virus]]
** [[Herpes simplex virus]]
**[[Staphylococcus aureus]]
**[[Streptococcus pyogenes]]
⚫
* Parasites
⚫
**[[Bacillus anthracis]] (cutaneous anthrax)
⚫
** [[Leishmania species]]
⚫
**[[Erysipelothrix rhusiopathiae]]
⚫
*'''Viruses'''
⚫
**[[Vaccinia virus]]
**[[Herpes simplex virus]]
⚫
*'''Parasites'''
⚫
**[[Leishmania]]
*'''Non-infectious causes'''
**Squamous cell carcinoma
**Basal cell carcinoma
**Mycosis fungoides
**Psoriasis
**Lupus vulgaris
**Pyoderma gangrenosum

==Further Reading==


*Nodular Lymphangitis (Sporotrichoid Lymphocutaneous Infections). Clues to Differential Diagnosis. ''J Fungi''. 2018;4(56). doi: [https://doi.org/10.3390/jof4020056 10.3390/jof4020056]


[[Category:Skin and soft tissue infections]]
[[Category:Skin and soft tissue infections]]

Latest revision as of 01:27, 7 February 2022

  • Characterized by purulent nodules appearing along the course of regional lymphatics

Differential Diagnosis

Common

Organism Distribution Exposures Incubation Initial presentation
Sporothrix schenckii South and Central America and southern North America gardening (especially roses), other soil contact, animal scratches or bites 1 week to 3 months painless ulcerated nodule
Mycobacterium marinum worldwide fish and aquariums, including salt- and freshwater exposures 1 to 6 weeks mildly tender, ulcerated nodule
Nocardia brasiliensis worldwide soil, cat scratch 3 days to 6 weeks tender, ulcerated, draining nodules
Leishmania brasiliensis South and Central America sand flies 2 to 24 weeks painless, punched-out shallow ulcer
Francisella tularensis North America wild animal exposures (especially hunting) or ticks 1 to 6 days painful ulcerated draining papule
Bacillus anthracis worldwide animal, animal product, or contaminated soil exposures painless ulcer with vesicles and edema
Staphylococcus aureus worldwide 4 to 10 days abscesses, with or without drainage
Coccidioides immitis Southwest US and northern Mexico soil exposure or laboratory exposure 1 to 4 weeks verrucous plaques and ulcerated nodules
Blastomyces dermatitidis worldwide, particularly North America soil, animal bites or scratches, laboratory exposure 1 to 5 weeks verrucous plaques and ulcerated nodules
Histoplasma capsulatum worldwide soil, birds, laboratory exposure 5 to 18 days myriad
Scedosporium worldwide soil, water, or sewage nodules
Herpes simplex virus worldwide 2 to 12 days vesicles
Vaccinia virus cattle and cats

Exhaustive List

Further Reading

  • Nodular Lymphangitis (Sporotrichoid Lymphocutaneous Infections). Clues to Differential Diagnosis. J Fungi. 2018;4(56). doi: 10.3390/jof4020056
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