lymphangitis

Lymphangitis is inflammation of the lymphatic vessels, usually arising as a complication of a skin infection such as cellulitis. Infected areas send inflammatory mediators into nearby lymphatics, causing characteristic red, streaky lesions that extend from the original site toward regional lymph nodes. The condition often presents with fever, malaise, and tender, swollen lymphatic pathways.

Common signs and symptoms include abrupt onset of fever, chills, and a painful, linear erythematous streak following the course of a lymphatic vessel. The affected area may be warm and tender, and regional lymph nodes may be enlarged. Lymphangitis can be more pronounced in the lower extremities or face, depending on the entry site of infection. In young children and older adults, symptoms can be more severe or rapidly progressive.

Most cases are caused by bacteria, particularly Streptococcus pyogenes and Staphylococcus aureus, entering through skin trauma, ulcers, wounds, or fissures. Underlying conditions such as impaired skin integrity, edema, or vascular disease increase risk.

Diagnosis is typically clinical, based on history and physical examination. Blood tests may show leukocytosis in more severe cases. Blood cultures or wound cultures may be obtained if systemic infection is suspected. Imaging is reserved for suspected abscess or deeper infection.

Treatment depends on severity. Mild cases are managed with oral antibiotics effective against streptococci and staphylococci (for example, penicillin or cephalexin; doxycycline or TMP-SMX may be used for MRSA coverage). Severe or systemic disease requires prompt hospitalization and intravenous antibiotics, along with wound care, analgesia, and limb elevation. Early treatment improves prognosis; complications can include bacteremia, abscess formation, or chronic lymphedema. Prevention focuses on prompt treatment of skin infections and good wound care.