• Ching-Hsiang Yu and Yu-Jang Su.
• Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
• Medicine (Baltimore). 2024 Sep 20; 103 (38): e39849e39849.

RationaleAcute infectious lymphangitis represents a common complication of cellulitis, typically attributed to streptococcal infections after damaged skin integrity.Patient ConcernThis is a 51-year-old woman with a medical history of relapsing polychondritis, managed with steroid and methotrexate therapy in the outpatient department. She presented with a progressive redness and swelling of the left hand, accompanied by purulent discharge, persisting for 5 days. The patient had sustained a small cutting wound from the gill of a narrow-barred Spanish mackerel (Scomberomorus commerson) while cooking previously.DiagnosisLymphangitis and cellulitis of the left forearm were diagnosed. A distinctive red streak was identified on the skin covering the palmaris longus muscle, consistent with the anatomical course of the median forearm lymphatic channel.InterventionsThe patient received empirical intravenous ciprofloxacin (400 mg every 12 hours) and was subsequently admitted to the infectious disease ward. During hospitalization, the antibiotic regimen was adjusted to ceftazidime on the fourth day (2 g every 8 hours). The redness and swelling in the hand and arm gradually improved, and her blood culture showed no bacteria growth.OutcomesShe was recovered and discharged on the seventh day with a prescription for oral clindamycin (150 mg every 6 hours).LessonsA red stripe along the lymphatic route indicates acute lymphangitis and requires hospitalization for parenteral antibiotics.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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