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Case Reports
. 2019 Aug 9;13(1):247.
doi: 10.1186/s13256-019-2165-x.

Lymph node abscess caused by Francisella tularensis - a rare differential diagnosis for cervical lymph node swelling: a case report

R Rothweiler  1 , M A Fuessinger  2 , R Schmelzeisen  2 , M C Metzger  2
Affiliations
Case Reports

Lymph node abscess caused by Francisella tularensis - a rare differential diagnosis for cervical lymph node swelling: a case report

R Rothweiler et al. J Med Case Rep. .

Abstract

Background: Cervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked. With an incidence of 120 cases in the United States of America (USA) and approximately 25 cases in Germany per year, infection with the pathogen Francisella tularensis is one of these rare diseases that can cause massive lymph node swellings and might even be fatal.

Case presentation: The example of a healthy 67-year-old German woman who was treated at our university hospital presents a typical progression of a localized form of tularemia. The pathogen could be identified in a universal 16S ribosomal deoxyribonucleic acid (DNA) polymerase chain reaction. Pathogen-specific treatment with lymph node abscess incision, daily rinsing of the abscess cavity, and orally administered antibiotic therapy with doxycycline could cure our patient completely without any remaining complications.

Conclusion: In patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment. Possible infections with atypical bacteria like Francisella tularensis should never be ignored. Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens.

Keywords: Abscess; Francisella tularensis; Infection; Unilateral lymph node.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Image of the local laceration in the upper left wisdom tooth region
Fig. 2
Fig. 2
Panoramic radiograph before tooth extraction
Fig. 3
Fig. 3
Sonographical image showing the extremely increased lymph nodes 25 days after tooth resection
Fig. 4
Fig. 4
Computed tomography image of the abscess formations in the left submandibular region
Fig. 5
Fig. 5
Irritation-free scar in the former left upper wisdom tooth region half a year after the infection
See this image and copyright information in PMC

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