OBJECTIVE: To evaluate the prevalence and associated factors involved in cellulitis with lymphangitis among a group of Korean patients who were being treated for lymphedema. We present our epidemiologic research and we also report a systematic review of these types of cases. METHODS: This was a retrospective medical record study among 1,246 patients diagnosed with lymphedema. The study was carried out between January 2006 and December 2012 at the Kosin University Gospel Hospital and Seoul National University Bundang Hospital. Cases were examined for onset time, affected site, seasonal trend, and recurrence pattern of lymphedema, lymphangitis, and cellulitis. We also evaluated the history of blood-cell culture and antibiotic use. RESULTS: Ninety-nine lymphedema patients experienced complications such as cellulitis with accompanying lymphangitis. Forty-nine patients had more than two recurrences of cellulitis with lymphangitis. The incidence and recurrence of cellulitis with lymphangitis were significantly higher in the patients with lower-extremity lymphedema. There was a significant trend toward higher cellulitis prevalence in the lower-extremity lymphedema group according to the time of lymphedema onset. Among the cellulitis with lymphangitis cases, 62 cases were diagnosed through blood-cell culture; 8 of these 62 cultures were positive for β-hemolytic streptococci. CONCLUSION: The prevalence rate of cellulitis with lymphangitis in patients with lymphedema was 7.95%, and the prevalence of recurrent episodes was 3.93%. Especially, there was high risk of cellulitis with lymphangitis after occurrence of lower-extremity lymphedema with passage of time. Lymphedema patients should be fully briefed about the associated risks of cellulitis before treatment, and physicians should be prepared to provide appropriate preventive education.
Cellulitis* ; Education ; Humans ; Incidence ; Lymphangitis ; Lymphedema* ; Medical Records ; Prevalence* ; Recurrence ; Retrospective Studies ; Seasons ; Seoul

Adolescent ; Adult ; Aged ; Bloodletting ; Child ; Child, Preschool ; Combined Modality Therapy ; Dermatitis ; therapy ; Female ; Humans ; Infant ; Insect Bites and Stings ; therapy ; Lymphangitis ; therapy ; Male ; Middle Aged ; Moxibustion ; Young Adult

Secondary lymphedema occurs when normal lymphatics suffer a significant insult such as cancer, radiation therapy, surgery, trauma, or infection. Recurrent infections such as cellulitis, lymphangitis, and cutaneous lymphorrhea are significant complications in lymphedematous sites. A 58-year-old man with endstage colon cancer was referred to our department with a skin lesion and persistent discharge on both legs. On histopathological examination, numerous dilated lymphatic channels which were D2-40 positive were seen in the dermis. Herein, we report an interesting case of lower extremity lymphedema in an endstage cancer patient complicated with persistent cutaneous lymphorrhea.
Cellulitis ; Colonic Neoplasms ; Dermis ; Humans ; Leg ; Lower Extremity* ; Lymphangitis ; Lymphedema* ; Middle Aged ; Skin

Nocardia is aerobic gram positive bacteria, which is found in the soil. Cutaneous nocardiosis is divided into the primary skin infection and secondary infection due to systemic dissemination from the internal organ. Its clinical manifestations are mycetoma, lymphocutaneous infection and superficial infection, such as abscess or granuloma. In lymphocutaneous infection, it is important to make differential diagnosis with other diseases with sporotrichoid pattern, such as sporotrichosis, leishmaniasis and mycobacterial infection. In our case, 58 year old male who had history of chemotherapy due to lung cancer visited with granulomatous nodule on the left wrist, and following lymphangitis along the forearm for 2 months. Through a skin biopsy, culture, AFB stain and 16S rRNA gene sequencing, cutaneous nocardiosis by N. brasiliensis was diagnosed.
Abscess ; Biopsy ; Coinfection ; Diagnosis, Differential ; Forearm ; Genes, rRNA ; Gram-Positive Bacteria ; Granuloma ; Humans ; Leishmaniasis ; Lung ; Lung Neoplasms ; Lymphangitis ; Male ; Mycetoma ; Nocardia ; Nocardia Infections ; Skin ; Soil ; Sporotrichosis ; Wrist

OBJECTIVETo study the significance and differential diagnosis of intralymphatic accumulation of lymphocytes.

METHODSThe clinical and pathologic features of 4 cases of intralymphatic accumulation of lymphocytes were reviewed retrospectively. Immunohistochemical study was carried out and follow-up data were analyzed.

RESULTSThe sites of involvement included tonsil (2 cases), pharynx (1 case) and appendix (1 case). The duration of disease ranged from 1 week to 3 months. Follow up of the patients (from 3 to 84 months) showed no evidence of disease recurrence. Gross examination of the tissues (except in the case of appendiceal involvement) showed polypoid changes. Histologically, the lymphatic channels were filled up with small lymphocytes and associated with fibrosis in the vicinity. Immunohistochemical study revealed a T-cell phenotype of the intralymphatic lymphoid cells.

CONCLUSIONSThe accumulation of lymphocytes in lymphatic channels is associated with a benign clinical course. This phenomenon may be due to retention of lymphocytes secondary to the perilymphatic chronic inflammation and fibrosis. Although the lesion simulates intravascular lymphomatosis morphologically and shows a uniform T-cell phenotype, the lymphoid cells lack obvious cellular pleomorphism and mitotic activity. The solitary nature of the lesion, when coupled with the indolent clinical behavior, is also helpful in the differential diagnosis.

Adolescent ; Adult ; Antibodies, Monoclonal, Murine-Derived ; metabolism ; CD3 Complex ; metabolism ; Child ; Diagnosis, Differential ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Lymphangitis ; metabolism ; pathology ; Lymphatic Diseases ; metabolism ; pathology ; Lymphatic Vessels ; pathology ; Lymphoma, B-Cell ; metabolism ; pathology ; Male ; Middle Aged ; Palatine Tonsil ; pathology ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; Retrospective Studies ; T-Lymphocytes ; pathology ; Young Adult

Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use, accessible and simple adjuvant tool for management of large soft tissue necrosis.
Animals ; Bites and Stings ; complications ; surgery ; Dermatologic Surgical Procedures ; Fishes, Poisonous ; Foot Injuries ; surgery ; Humans ; Lymphangitis ; etiology ; surgery ; Male ; Middle Aged ; Necrosis ; Negative-Pressure Wound Therapy ; Skin ; pathology ; Skin Transplantation

This report describes the color and pulsed Doppler US findings of penile Mondor's disease. The pulsed Doppler US findings of penile Mondor's disease have not been previously published, so we report here for the first time on the cavernosal arterial flow signal pattern of penile Mondor's disease. Penile Mondor's disease is rare disease that's characterized by thrombosis in the dorsal vein of the penis. The previous reports on penile Mondor's disease are concerned with the color Doppler US finding without the flow signals in this area, but these findings are insufficient to understand the hemodynamics in penile Mondor's disease. We report for the first time on a cavernosal artery flow signal pattern of low peak systolic velocity and high-resistance.
Adult ; Blood Flow Velocity ; Humans ; Lymphangitis/*ultrasonography ; Male ; Penile Diseases/*ultrasonography ; Penis/*blood supply/*ultrasonography ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Pulsed ; Venous Thrombosis/*ultrasonography

INTRODUCTION: Lymphedema develops due to the abnormality of the transport capacity of the lymphatic system. Clinically lymphedema is not only a cosmetic deformity, but also a disabling and distressing condition. CLASSIFICATION: Primary lymphedema is an inborn defect caused by such condition as absence or underdevelopment of the lymphatic system. It occurs in approximately 1 in 10,000 persons less than 20 years of age, with females being affected more frequently than males. Secondary lymphedema is an acquired condition resulting from loss or obstruction of the previously normal lymphatic system due to infection, tumor, filariasis and other miscellaneous conditions. CLINICAL FEATURES: Clinical symptoms and signs depend on the duration and the severity of the lymphedema. In the early stage of disease, the edema is soft and pits easily with pressure (pitting edema) and may decrease or disappear with elevation of the limbs. In the advanced stage, the skin texture turns woody as the surrounding tissue becomes indurated and fibrotic. DIAGNOSIS: Lymphangiography was introduced in the early 19th century. But there are several drawbacks to this procedure, including the complexity of the procedure, irradiation by contrast agent that may result in lymphangitis and potentially worsen the lymphedema. Lymphoscintigraphy is easier to perform than lymphangiography and is not reported to cause lymphangitis. Lymphoscintigraphy is gradually replacing lymphangiography. TREATMENT: The mainstay of the treatment is complex decongestive physical therapy including leg elevation, elastic or rigid compression, manual lymph drainage, and intermittent pneumatic compression. When the function of the limb is significantly impaired, surgical reduction is considered. The surgery is not curative, but it can make the disorder more manageable by complex decongestive physical therapy.
Classification ; Congenital Abnormalities ; Diagnosis ; Drainage ; Edema ; Extremities ; Female ; Filariasis ; Humans ; Leg ; Lymphangitis ; Lymphatic System ; Lymphedema* ; Lymphography ; Lymphoscintigraphy ; Male ; Skin

Sclerosing lymphangitis of the penis is a rare condition involving the distal lymphatics that is characterized by cord-like lesions on the shaft or coronal sulcus. Although the etiology is unknown, its association with mechanical trauma, anatomic variants, or infection has been shown. Clinically, the patient notices a painless, firm, cord-like lesion just proximal to the sulcus. Histologic study reveals hypertrophy and sclerosis of lymphatic vessel walls and, in some cases, thrombus formation within the dilated vessels. Most cases are self-limited, and conservative management is indicated, but surgical excision is warranted for persistently symptomatic lesions. We report three cases of sclerosing lymphangitis of the penis that required treatment by surgical excision.
Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

BACKGROUND: Because it has been known that the inflammatory process of cellulitis can be modified by the immune reaction, systemic corticosteroid may be helpful to reduce the inflammatory reaction of the cellulitis and its consequent complications such as skin necrosis and lymphangitis. OBJECTIVE: The purpose of this study was as follows; To find out the appropriate and objective examination methods to evaluate the improvement of cellulitis. To estimate the efficacy of the systemic corticosteroid of short period in the treatment of cellulitis. METHODS: First, as methods of evaluation of therapeutic effectiveness, we measured the lesional skin temperature, circumference of extremity and subjective tenderness in two groups-patients with cellulitis and controls to find out the objective tools showing the improvement of cellulitis. Second, we also measured the skin temperature, circumference of extremity and subjective tenderness in another two groups-patients with systemic corticosteroid and those without to evaluate the effect of systemic corticosteroid in cellulitis. RESULTS: The results were as follows ; Measurements of the skin temperature, circumference and subjective tenderness all showed statistic significance to evaluate the improvement of cellulitis. Patients who were treated with systemic corticosteroid showed statistically better improvement than control group in the lesion of cellulitis. CONCLUSION: The lesional skin temperature, circumference and tenderness can be an objective evaluation method of clinical effectiveness and the systemic corticosteroid may be as adjunct to improvement of the cellulitis.
Cellulitis* ; Extremities ; Humans ; Lymphangitis ; Necrosis ; Skin ; Skin Temperature