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Case Reports
. 2018 Nov 12:11:313-318.
doi: 10.2147/IMCRJ.S178561. eCollection 2018.

A case of ulceroglandular tularemia presenting with lymphadenopathy and an ulcer on a linear morphoea lesion surrounded by erysipelas

Alessandra Balestra  1 , Hekuran Bytyci  1 , Caroline Guillod  2 , Antonio Braghetti  3 , Luigia Elzi  4
Affiliations
Case Reports

A case of ulceroglandular tularemia presenting with lymphadenopathy and an ulcer on a linear morphoea lesion surrounded by erysipelas

Alessandra Balestra et al. Int Med Case Rep J. .

Abstract

Tularemia is a zoonosis caused by the infection of Francisella tularensis (a gram-negative aerobic bacterium). Transmission to other animals or humans usually occurs through insect or tick bites, direct contact with a contaminated environment (mud or water), infected animals - mainly lagomorphs - or by ingesting undercooked meat or inhaling contaminated dust (hay or soil). This paper discusses the case of a 32-year-old man, who came to our Emergency Room presenting with persistent fever, inguinal lymphadenopathy, and an ulcer on his left lower limb on a linear morphoea lesion that had been there for some time. The lesion was surrounded by erysipelas. After hospitalization and tests, the patient was diagnosed with ulceroglandular tularemia. Antibiotic treatment with doxycycline resolved the clinical picture, but not the morphoea lesion.

Keywords: Francisella tularensis; erysipelas; lagomorphs; tularemia; zoonosis.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
An inguinal ultrasound examination showed subcutaneous edema and numerous benign reactive enlarged lymph nodes.
Figure 2
Figure 2
A 12×6 mm pretibial ulcer with a fibrin bed on the linear morphoea lesion and erythema with ill-defined borders.
Figure 3
Figure 3
Erythematous lymph nodes on the medial side of the ipsilateral thigh up to the groin. Note: Two small ulcerated lesions at malleolar level.
See this image and copyright information in PMC

References

    1. Bundesamt für Gesundheit – Abteilung Übertragbare Krankheiten . Tularämie/Hasenpest. Bern, Switzerland: Bundesamt für Gesundheit; [Accessed September 29, 2018]. Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberbli....
    1. Geyer SJ, Burkey A, Chandler FW. Tularemia. In: Connor DH, editor. Pathology of Infectious Diseases. Stamford, CT: Appleton & Lange; 1997. p. 869.
    1. Gürcan Şaban. Epidemiology of Tularemia. Department of Medical Microbiology, Trakya University Faculty of Medicine, Edirne, Turkey. Balkan Med J. 2014;31(1):3–10. - PMC - PubMed
    1. Grunow R, Kalaveshi A, Kühn A, Mulliqi-Osmani G, Ramadani N. Surveillance of tularaemia in Kosovo, 2001 to 2010. Euro Surveill. 2012;17(28):20217. - PubMed
    1. Jackson J, Mcgregor A, Cooley L, et al. Francisella tularensis subspecies holarctica, Tasmania, Australia, 2011. Emerg Infect Dis. 2012;18(9):1484–1486. - PMC - PubMed

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