To make this post fun, I created hypothetical scenarios. This will help making a differential diagnosis =)
Scenario 1: Patient is a rose gardener.
Scenario 2: Patient is an aquarium cleaner.
Scenario 3: Patient is a vegetable labourer in a farm. Honey colored drainage is seen at the site of ulceration. It is followed by subcutaneous nodules draining the primary lesion.
Scenario 4: There was a painful chancre at the primary lesion. After 5 days, tender lymphadenitis developed.
Answers:
Scenario 1: Sporothrix schenckii
Scenario 2: Mycobacterium marinum
Scenario 3: Lymphocutaneous disease by nocardia brasiliensis.
Scenario 4: Tularemia
Reading material:
Sporotrichosis, often occurring in gardeners, remains the most recognized cause of nodular lymphangitis.
Injuries sustained in marine environments suggest Mycobacterium marinum infection.
An incubation time of 1 to 5 days, a painful chancre at the initial lesion site, and prominent tender lymphadenitis strongly implicate tularemia.
Frankly purulent discharge from the primary lesion is associated with some infections due to Francisella and Nocardia species.
That's all!
-IkaN
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