Creeping lymphangitis.

A 35 year old man presented with a two day history of a tender rash on the right thigh. Examination showed serpiginous erythema extending from a vesiculopustule on his right thigh. Staphylococcus aureus was identified in a culture of the vesiculopustular fluid. The diagnosis of lymphangitis spreading from folliculitis was made. The patient was successfully treated with oral ampicillin. Learning point: • Lymphangitis is a rare complication of bacterial infections and insect bites • A recent study in the United States reported an incidence of 0.16 per 1000 person years • It usually appears as a red straight streak, but serpiginous streaks can also be seen from the course of travel along the lymphatic vessels Patient consent obtained.