Medicina Fluminensis, Vol. 61 No. 2, 2025.
Case report, case study
https://doi.org/10.21860/medflum2025_330055
Tularemia – A Rare Cause of Lymphadenopathy in Children: A Case Report
Karlo Gjuras
orcid.org/0009-0006-9137-3014
; Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, Hrvatska
*
Ivna Tomaš
orcid.org/0009-0001-3785-8807
; Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, Hrvatska
Lorna Stemberger Marić
; Klinika za infektivne bolesti „Dr. Fran Mihaljević“, Zavod za infektivne bolesti djece, Zagreb, Hrvatska
* Corresponding author.
Abstract
Aim: This study aims to present the differential diagnostic challenge of evaluating lymphadenopathy in the pediatric population and to consider rare causes such as Francisella tularensis. Case report: An eight-year-old boy presented at the end of September with a six-day fever. The patient resides in Mala Mlaka and owns a cat. However, he could not definitively exclude a scratch or bite. He denied contact with rabbits and tick bites. A papule emerged on the back of his right thigh on the fifth day of illness, developing a central depression and eventually resulting in a shallow ulcer. Right inguinal lymphadenopathy was noted two weeks after the onset of the fever. A five-day course of azithromycin therapy was initiated for suspected cat scratch disease. Persistent lymphadenopathy and lymphadenitis prompted a serological investigation, ruling out bartonellosis. Ultrasound detected a thigh subcutaneous tissue abscess. Pus obtained from the abscess puncture tested positive for the F. tularensis genome by polymerase chain reaction. The diagnosis of ulceroglandular tularemia was confirmed. Treatment consisted of a ten-day course of parenteral gentamicin therapy, followed by four days of oral ciprofloxacin post-discharge. Conclusion: Tularemia is a rare disease, with only two cases recorded in Croatia from 2018 to 2022. Lymphadenopathy caused by tularemia in the pediatric population represents a diagnostic challenge due to its low incidence. A positive epidemiological history and the presence of a primary lesion can aid in diagnosis.
Keywords
abscess; Francisella tularensis; lymphadenopathy; tularemia; zoonoses
Hrčak ID:
330055
URI
Publication date:
1.6.2025.
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