Lymphangitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]Vishal Devarkonda, M.B.B.S[3]


The presentation of red streaks on the skin in lymphangitis can also be a presentation of conditions such as contact dermatitis, cellulitis, thrombophlebitis, fasciitis and myositis. Clinical findings like red linear streaks proximal to a distal site of infection, tender regional lymphadenopathy and fever, along with a history suggestive of infection by causative organisms of lymphangitis helps in differentiating lymphangitis from other conditions.[1]

Differentiating Lymphangitis from other Diseases

  • Contact dermatitis: Contact dermatitis is characterized by onset of symptoms like itching, burning and pain within minutes to hours following exposure to an environmentally relevant allergen and is associated with clinical findings like macular erythema, fissures, or vesicles. Clinical evidences like distal site of infection and tender regional lymphadenopathy are absent.
  • Myositis: Typical cutaneous lesions along with symmetric proximal muscle weakness, elevated serum muscle enzymes, electromyographic finding of myopathic changes, and characteristic muscle biopsy abnormalities are characteristic of myositis.[2]
  • Necrotizing fasciitis: Gradual in onset and later rapid in progression of clinical features like fever, pain, swelling, crepitus, and foul-smelling wound drainage following trauma, surgery, or spread of an infection from a near by tissue or organ, along with signs of systemic toxicity and elevated serum creatine kinase levels are suggestive of necrotizing fasciitis. Surgical exploration establishes the diagnosis.[3]
  • Septic thrombophlebitis: Septic thrombophlebitis presents with clinical manifestations like fever, erythema, tenderness and purulent drainage at the site of an involved vessel in the setting of an intravascular catheter and persistent bacteremia. Further laboratory studies and radiological evidence establishes the diagnosis and differentiates it from lymphangitis.[4]
  • Superficial thrombophlebitis: Clinical findings like erythema, tenderness, induration, or palpable nodular cords along the course of a superficial vein is suggestive of superficial thrombophlebitis. Further evaluation with duplex ultrasound or laboratory studies helps in establishing the diagnosis while differentiating it from lymphangitis.[5]


  1. lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
  2. Bohan A, Peter JB (1975). "Polymyositis and dermatomyositis (second of two parts)". N Engl J Med. 292 (8): 403–7. doi:10.1056/NEJM197502202920807. PMID 1089199.
  3. Majeski J, Majeski E (1997). "Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment". South Med J. 90 (11): 1065–8. PMID 9386043.
  4. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMID 19489710.
  5. Samlaska CP, James WD (1990). "Superficial thrombophlebitis. II. Secondary hypercoagulable states". J Am Acad Dermatol. 23 (1): 1–18. PMID 2195069.

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