Requested DocAlert: Picture Quiz Poll: Creeping Redness on a Young Man’s Thigh

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Information sourced from BMJ:

BMJ 2015;351:h5416
[Free full-text BMJ article PDF]

Endgames

Case Scenario

Creeping lymphangitis

Shota Takashima, Mitsuhito Ota

Correspondence to: M Ota ota@med.hokudai.ac.jp

A 35 year old man presented with a two day history of a tender rash on the right thigh. Examination showed serpiginous erythema extending from a vesiculopustule on his right thigh. Staphylococcus aureus was identified in a culture of the vesiculopustular fluid. The diagnosis of lymphangitis spreading from folliculitis was made. The patient was successfully treated with oral ampicillin.

Learning point:

Lymphangitis is a rare complication of bacterial infections and insect bites
A recent study in the United States reported an incidence of 0.16 per 1000 person years
It usually appears as a red straight streak, but serpiginous streaks can also be seen from the course of travel along the lymphatic vessels
Patient consent obtained.

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