title: Nodular lymphangitis: Report of a case with presentation of a diagnostic paradigm.
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.
authors.affiliation: University at Buffalo School of Medicine and Biomedical Sciences, USA.
authors.forename: Cerrene Nicole
authors.initials: CN
authors.lastname: Giordano
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kalb
authors.forename: Corstiaan
authors.initials: C
authors.lastname: Brass
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Helm
mesh_terms: D001132:Arm; D003937:Diagnosis, Differential; D006225:Hand; D006801:Humans; D007891:Leishmania; D008205:Lymphangitis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy; D015269:Mycobacterium avium Complex; D019910:Mycobacterium marinum / Q000302:isolation & purification*; D009615:Nocardia; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D013175:Sporothrix