What is Lymphangitis? Lymphangitis is an inflammation of the lymphatic vessels. It can be acute or chronic and may affect superficial lymphatics (superficial lymphangitis) or deep lymphatics (deep lymphangitis). It can also manifest as a reticular pattern when the dermal lymphatic network is involved (referred to as acute erysipeloid lymphangitis, due to its similarities with erysipelas) or as a truncal pattern when major lymphatic trunks are primarily affected.

Lymphangitis:

From an etiopathogenetic perspective, lymphangitis has various triggering causes. The most common cause is infection, especially related to streptococci (such as Group A beta-hemolytic Streptococcus), staphylococci (such as Staphylococcus aureus), E. coli, and pneumococci. Occasionally, lymphangitic manifestations can result from trauma or be associated with systemic inflammatory conditions (as seen in rheumatic diseases).

The immune system in the limb affected by lymphatic stasis often exhibits a kind of “deficiency,” which is not so much due to cellular alteration as in systemic immunodeficiencies, but rather to the relative difficulty of movement of the cells responsible for ensuring an adequate immune response (such as macrophages, Langerhans cells, or more generally, Antigen Presenting Cells). For this reason, a minor injury (like an insect bite) is often sufficient to allow the free penetration of saprophytic germs and trigger a lymphangitic episode. 

Clinically, lymphangitis can present a serious clinical challenge. Depending on the type of microbes entering the body, their bacterial load, and the local immunodeficiency of the affected individual, extremely acute conditions can develop. In some cases, these conditions can progress to a confirmed septicemia, with a highly compromised overall condition, necessitating the patient’s admission to an intensive care unit for closer monitoring of vital signs. 

More commonly, acute lymphangitis manifests with widespread erythema in the affected limb, displaying all five signs of inflammation (redness, heat, pain, swelling, and loss of function). This is often accompanied by fever, with axillary temperatures reaching up to 41°C, with or without chills. Antibiotic therapy combined with symptomatic treatment (pain relief, antipyretics), administered in a hospital setting, is currently the treatment of choice. 

For patients with lymphedema or other conditions associated with lymphatic stasis, a prophylactic regimen of delayed-release penicillins (intramuscular administration every 2-3 weeks) can be beneficial in preventing this serious complication. 

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