Concerning Linear Mark Following Insect Bite in Pregnant Patient

Case at a Glance

A 30-year-old pregnant woman presents with a persistent insect bite at the base of her neck accompanied by a linear marking, raising concerns about possible lymphangitis or systemic infection.

Patient's Story

The patient, a 30-year-old gravid female currently managing seasonal allergies with antihistamines and using sleep aids, reported sustaining what she believed to be a mosquito bite at the base of her neck approximately one week prior to presentation. She noted that a linear mark appeared adjacent to the bite site within 24 hours of the initial injury. The lesion has remained unchanged in size and continues to cause significant pruritus. The patient expressed concern about potential bloodstream infection after reading about similar cases online. She denies fever, malaise, or other systemic symptoms.

Initial Assessment

Patient appeared well and afebrile. Vital signs were stable and appropriate for gestational age. Physical examination revealed a localized erythematous lesion at the base of the neck with an associated linear marking. No lymphadenopathy was palpated. The surrounding tissue appeared normal without signs of spreading cellulitis or abscess formation.

The Diagnostic Journey

Given the patient's pregnancy status and concerns about potential lymphangitis, a thorough evaluation was warranted. The static nature of the lesion over one week, absence of systemic symptoms, and lack of progressive erythema suggested a benign etiology. Differential diagnosis included simple insect bite reaction, contact dermatitis, or early lymphangitis.

Final Diagnosis

Localized arthropod bite reaction with associated linear dermatitis, likely representing a benign inflammatory response rather than infectious lymphangitis.

Treatment Plan

Conservative management was recommended given the benign appearance and stable clinical course. Continued use of antihistamines for symptomatic relief of pruritus. Patient education provided regarding warning signs that would necessitate immediate medical attention, including fever, spreading erythema, or systemic symptoms.

Outcome and Follow-up

Patient was reassured about the likely benign nature of the lesion. Instructions provided for close monitoring and return if any concerning changes develop. Routine prenatal care to continue as scheduled with her obstetrician.