Department of Angiology, Dijon Bourgogne University Hospital, 14, rue Paul Gaffarel, 21000 Dijon, France

Upper-limb acute superficial lymphatic is a rare condition that, to date, has received little attention in the medical literature. It can complicate a skin punch biopsy and mimic superficial venous thrombosis.

Lymphatic thrombosis, unfavourable effects, coagulation, acute lymphangitis, and skin biopsy

A 56-year-old patient with acute lymphangitis, hyperleukocytosis, and left arm cellulitis was admitted to the hospital. An aspiration of the bone marrow revealed acute monocytic leukaemia (93% blasts). As soon as the antibiotics and induction chemotherapy were started, the leucocyte count quickly returned to normal. A 6-mm punch biopsy of an erythematous plaque in the route of the lymphangitis on the sixteenth day revealed keratinocyte necrosis, a dermal non-specific histiocyte-rich infiltrate, but no sign of leukemic infiltration (Figure 1). Numerous lymphatics were seen by Podoplanin immunostaining (Figure 2). The following day, a thick, erythematous cord was found extending upstream from the biopsied location (Figure 3). Leukocytes were 9.5 109/L, C-reactive protein was negative, D-dimers were 2530 g/L, and the upper-limb blood and skin samples were sterile. Doppler ultrasound ruled out venous thrombosis and revealed a 6- mm- diameter incompressible non- circulating channel; so, the diagnosis of superficial acute lymphatic thrombo-sis was made. The antibiotics were continued for 7 days, and enoxaparin 40 mg daily was prescribed for 6 weeks, resulting in complete remission.Lymphatics lack platelets and have high levels of anti- thrombin, yet they contain all of the coagulation proteins.1,2 We assume here that biopsy- related endothe-lial alterations and chronic lymph flow obstruction in a pro-coagulant inflammatory context entailed the lymph thrombosis.

The study's concept and design were created by Rémy Hamdan. Patients were supervised by Rémy Hamdan, Ilham Abejiou, Nicolas Briche, and Ingrid Lafon. The data were interpreted by Lounes Djerroudi and Rémy Hamdan. Data collection involved Nicolas Briche and Rémy Hamdan. The manuscript was authored by Vanessa Gasmi and Rémy Hamdan. The paper has been read and approved by all authors.

Due to the fact that no data sets were created or examined during the current investigation, data sharing was not applicable to this publication.

In accordance with the patient consent policy of the journal, patient consent has been signed and obtained.

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Rémy Hamdan. A case report of upper-limb acute superficial lymphatic thrombosis. Insights of Clinical and Medical Images 2022.