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A boy aged 8 years presented with recurrent erythematous streaks on the anterior chest.
The first episode occurred in spring with a pruritic linear eruption on the left side after an insect bite at night. The lesion extended from the area of the bite towards the left axillary fold (figure 1A). He was in excellent general condition without fever or lymph node enlargement. He took no medications and his medical history was unremarkable. He was treated with amoxicillin clavulanate for acute bacterial lymphangitis. The eruption resolved within hours.
The second episode occurred in summer with identical linear eruptions after several insect bites on the right side (figure 1B). Based on the patient’s history and clinical presentation, superficial lymphangitis after insect bite was diagnosed. The lesions disappeared after a few hours without any treatment.
Superficial lymphangitis after insect bite is an underestimated entity mimicking acute bacterial lymphangitis.1 Only a few cases have been described so far.1–4 In contrast to infection, the site of insect bites from which lymphangitis emanates is pruritic and not painful or tender.5 Other characteristic features are the absence of fever and lymph node enlargement and a rapid spontaneous regression.1 The highest intensity of the linear erythema is at the site of insect bites.5 Leucocytes and C-reactive protein are normal.1 2 Pathogenesis likely involves an allergic immune reaction to insect toxins.1 The diagnosis should be considered particularly when recurrent or multifocal lymphangitis occurs after insect bites. Antibiotics should be avoided in such cases. Treatment remains symptomatic.
Footnotes
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.