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Red stripe on left forearm after stung by fish gill: A case report
Ching-Hsiang Yu1, Yu-Jang Su1,2,3,4
1Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Rationale:
Acute infectious lymphangitis represents a common complication of cellulitis, typically attributed to streptococcal infections after damaged skin integrity.
Patient Concern:
This 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.
Diagnosis:
Lymphangitis 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.
Interventions:
The 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.
Outcomes:
She was recovered and discharged on the seventh day with a prescription for oral clindamycin (150 mg every 6 hours).
Lessons:
A red stripe along the lymphatic route indicates acute lymphangitis and requires hospitalization for parenteral antibiotics.
