Background: Acute bacterial lymphangitis is a common occurrence after skin damage. This diagnosis is often made in case of red linear streaks after arthropod bites, leading to the prescription of oral antibiotics. In this setting, noninfectious superficial lymphangitis after arthropod bites, an eruption rarely mentioned in the medical literature, appears as a diagnostic challenge. Objective: Our purpose was to study the clinical and histopathological features of this underrecognized condition. Methods: We collected the observations of six consecutive patients seen between the years 2003 and 2006, who developed an acute linear erythematous eruption along lymphatic vessels, mimicking common bacterial lymphangitis. Standard histological examinations were completed by immunopathological staining using the monoclonal antibody D2-40, a highly selective marker of lymphatic endothelium. Extensive review of the literature about acute noninfectious superficial lymphangitis was performed. Results: The clinical presentation and histological findings excluded an infectious etiology and suggested superficial lymphangitis after an arthropod bite in all the observations. Conclusions: This article analyzes the clinical and histological features of noninfectious superficial lymphangitis after arthropod bite, a benign underrecognized condition mimicking common bacterial lymphangitis. Physicians should be aware of this benign reaction to avoid the useless prescription of antibiotics.

1.
Smego RA, Castaglia M, Asperilla MO: Lymphocutaneous syndrome. Medicine (Baltimore) 1999;78:38–63.
2.
Lee PK, Weinberg AN, Schwartz NM, Johnson RA: Pyodermas: Staphylococcusaureus, Streptococcus and other gram-positive bacteria; in Freedberg IM, Eisen AZ, Wolff K, et al (eds): Fitzpatrick’s Dermatology in General Medicine. New York, McGraw-Hill, 2003, pp 2182–2207.
3.
Kahn HJ, Bailey D, Marks A: Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi’s sarcoma and a subset of angiosarcoma. Mol Pathol 2002;5:434–440.
4.
Niakosari F, Kahn HJ, Marks A, From L: Detection of lymphatic invasion in primary melanoma with monoclonal antibody D2-40. Arch Dermatol 2005;141:440–444.
5.
Ahmed I, Charles-Holmes R: Phytophotodermatitis mimicking superficial lymphangitis. Br J Dermatol 2000;142:1069.
6.
Rook A: Skin diseases caused by arthropods and other venomous or noxious animals; in Rooks A, Wilkinson DS, Ebling FJG (eds): Rook’s Textbook of Dermatology, ed 3. Oxford, Blackwell Science, 1979, vol 2, pp 911–913.
7.
Wilson DC, King LE: Arthropod bites and stings; in Freedberg IM, Eisen AZ, Wolff K, et al (eds): Fitzpatrick’s Dermatology in General Medicine. New York, McGraw-Hill, 2003, pp 2685–2695.
8.
Smith LR, Honig PJ: Lymphangitis of the anterior chest wall. Arch Dermatol 1980;26:412–413.
9.
Uhara H, Saida T, Watanabe T, et al: Lymphangitis of the foot demonstrating lymphatic drainage pathways from the sole. J Am Acad Dermatol 2001;47:502–504.
10.
Abraham S, Tschanz C, Krischer J, Saurat JH: Lymphangitis due to insect sting. Dermatology 2007;215:260–261.
11.
Kano Y, Inaoka M, Shiohara T: Superficial lymphangitis with interface dermatitis occurring shortly after a minor injury: possible involvement of a bacterial infection and contact allergens. Dermatology 2001;203:217–220.
12.
Guill MAJ, Odom RB: Evans blue dermatitis. Arch Dermatol 1979;115:1071–1073.
13.
Hasson A, Zamora E, Gutierrez MC, et al: Postlymphography linear dermatitis. Dermatologica 1991;183:283–285.
14.
Dilaimy M: Lymphangitis caused by cantharidin. Arch Dermatol 1975;111:1073.
15.
Stazzone AM, Borgs P, Witte CL, Witte MH: Lymphangitis and refractory lymphoedema after treatment with topical cantharidin. Arch Dermatol 1998;134:104–106.
16.
Allen AL, Fosko SW: Lymphangitis as a complication of intralesional bleomycin therapy. J Am Acad Dermatol 1998;39:295–297.
17.
Surana NK, St Geme JW: Lymphangitis after self-administration of polysaccharide. N Engl J Med 2005;352:944–945.
18.
Friedman SJ, Butler DF, Pittelkow MR: Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy. J Am Acad Dermatol 1998;19:537–541.
19.
Baer RL, Bickers DR: Allergic contact dermatitis, photoallergic contact dermatitis and phototoxic dermatitis; in Good RA, Day SB (eds): Comprehensive Immunology. New York, Plenum Publishing, 1981, pp 259–271.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.