Nodular lymphangitis

• 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

• Fungi
  • Sporothrix schenckii: gardening or dirt exposure
  • Blastomyces dermatitidis
  • Coccidioides immitis
  • Histoplasma capsulatum
  • Cryptococcus neoformans
  • Scedosporium apiospermum
  • Fusarium
  • Scopulariopsis blochii
  • Eumycotic mycetoma
  • Rhinocladiella aquaspersa (chromoblastomycosis)
• Bacteria
  • Norcardia species, including N. brasiliensis, N. asteroides, N. otidiscaviarum, and N. transcalensis: soil or water exposure
  • Mycobacterium tuberculosis (tuberculosis cutis verrucosa)
  • Non-tuberculous mycobacteria
    • Mycobacterium marinum: saltwater or marine exposure
    • Mycobacterium chelonei
    • Mycobacterium fortuitum
    • Rarely Mycobacterium kansasii
  • Francisella tularensis (ulceroglandular tularemia): excrutiatingly painful; hunting; deer flies and ticks
  • Burkholderia pseudomallei (melioidosis)
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Bacillus anthracis (cutaneous anthrax)
  • 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: 10.3390/jof4020056