Nonbacterial Causes of Lymphangitis With Streaking

Brandon E. Cohen, MD; Arielle R. Nagler, MD; Miriam Keltz Pomeranz, MD


J Am Board Fam Med. 2016;29(6):808-812. 

In This Article

Abstract and Introduction


Background: Lymphangitic streaking, characterized by linear erythema on the skin, is most commonly observed in the setting of bacterial infection. However, a number of nonbacterial causes can result in lymphangitic streaking. We sought to elucidate the nonbacterial causes of lymphangitic streaking that may mimic bacterial infection to broaden clinicians' differential diagnosis for patients presenting with lymphangitic streaking.

Methods: We performed a review of the literature, including all available reports pertaining to nonbacterial causes of lymphangitic streaking.

Results: Various nonbacterial causes can result in lymphangitic streaking, including viral and fungal infections, insect or spider bites, and iatrogenic etiologies.

Conclusion: Awareness of potential nonbacterial causes of superficial lymphangitis is important to avoid misdiagnosis and delay the administration of appropriate care.


Lymphangitic streaking is characterized by linear erythema extending proximally toward regional lymph nodes, reflecting underlying inflammation of the superficial lymphatic vessels. Lymphangitic streaking is most often described in association with acute bacterial infections, such as Staphylococcus aureus, Streptococcus pyogenes, and Pasteurella multocida infections.[1,2] Consequently, the presence of lymphangitic streaking often leads clinicians to treat patients with systemic antibiotics.[2] However, superficial lymphangitis may also occur as a result of a variety of other nonbacterial etiologies, such as viral or fungal infections, arthropods bites, or iatrogenic interventions (Table 1).

The recognition of nonbacterial causes of lymphangitic streaking can be challenging. Accordingly, awareness of potential nonbacterial etiologies is important to avoid misdiagnosis, unnecessary antibiotic treatment, and a delay in the administration of appropriate treatments. Therefore we conducted a comprehensive review of the literature to characterize better the nonbacterial etiologies of lymphangitic streaking. All relevant English-language reports available through the PubMed/MEDLINE and Google Scholar databases were considered. Search terms included the terms lymphangitic streaking, superficial lymphangitis, or cutaneous infection, and one of the following terms: nonbacterial, viral, or fungal infection.