Exposure: innoculation from an environmental source (see previous section)
Location: usually on the hand, less often on the foot, and infrequently anyplace else on the body
Incubation period: 1 to 12 weeks
Clinical findings:
(1) an erythematous papule or nodule develops at the site of innoculation, which may ulcerate
(2) development of erythematous nodules that may ulcerate running along a lymphatic channel draining the innoculation site
(3) regional lymphadenopathy
(4) systemic findings are typically absent
(5) lesions may wax and wane over time
Superficial cultures of the ulcers or draining fluid may be negative or yield bacteria that have secondarily infected the lesions. Many patients are treated with a variety of antibiotics without clinical improvement.
Biopsy of the lesions with histologic examination and fungal cultures can often establish the diagnosis.
Differential diagnosis: other causes of nodular lymphangitis (see below).
