II. Causes

  1. Common Causes
    1. Sporotrichosis: Sporothrix schenckii (fungus)
      1. Classic prototype of 'sporotrichoid' infection
      2. Gardening, splinters or Animal Bites or scratches
    2. Nocardia brasiliensis (Nocardiosis)
      1. Gardening or splinter exposure
    3. Mycobacterium marinum
      1. Aquariums, fish handling or other water exposure
    4. Leishmania brasiliensis (Leishmaniasis)
      1. Limited to sandfly endemic areas
  2. Other Causes
    1. Nocardia asteroides
    2. Atypical Mycobacteria
    3. Francisella tularensis
    4. Blastomyces dermatidis
    5. Coccidioides immitis
    6. Cryptococcus neoformans
    7. Histoplasma capsulatum
    8. Streptococcus Pyogenes
    9. Staphylococcus aureus
    10. Pseudomonas pseudomallei
    11. Bacillus anthracis (Anthrax)
    12. CowpoxVirus

III. Signs and Symptoms

  1. Exposure to soil or water borne organisms
  2. Granulomatous reaction up extremity lymph chain
    1. Nodular lesions
    2. Local tissue necrosis
    3. Abscess formation
  3. No systemic symptoms

IV. Differential Diagnosis

  1. See Subcutaneous Nodule (e.g. Rheumatoid Nodule)
  2. Cellulitis with ascending lymphangitis

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