SHM Converge Scientific Abstract ePoster Gallery-"Hopping" State Lines: An Unusual Cause of Fever in Michigan

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This case report describes an 83-year-old Michigan man who developed several weeks of fever, night sweats, and weight loss without clear localizing symptoms. His history included many potential environmental exposures: a recent tick bite, swimming in a lake, handling animal remains and droppings, hunting rabbits, and trapping field mice. Despite extensive evaluation, blood cultures, viral testing, and CT imaging were unrevealing. He also had intermittent fever with bradycardia, consistent with Faget sign, which can occur in tularemia.<br /><br />Because of suspicion for infection, he was discharged on empiric doxycycline. Subsequent serology showed positive Francisella tularensis IgM, confirming acute tularemia. The authors suggest he likely had the typhoidal form, which causes systemic illness without the classic ulcer or lymph node findings seen in ulceroglandular disease.<br /><br />Tularemia is rare in Michigan, with only a handful of cases reported there from 2011–2020 compared with over 2,000 cases nationally. The report emphasizes that climate change and shifting animal/vector habitats may expand the geographic range of zoonotic infections. Clinicians should therefore include tularemia and other regionally unusual infections in the differential diagnosis of fever of unknown origin, especially when exposure history suggests possible zoonotic transmission.

Asset Subtitle

Mark D. Adame

Meta Tag

Author List Mark D. Adame, Paul J. Grant, Rodney Ahdoot

Category Clinical Vignettes

Concept Tularemia

Concept Francisella tularensis

Concept Ulcero-Glandular Disease

Concept Fever of Unknown Origin

Concept Tick Bite

Distinguished Non-Finalist

Presenter Organization University of Michigan Medical School

Presenting Author Mark D. Adame

Track Adult

Keywords

tularemia

Francisella tularensis

fever of unknown origin

zoonotic infection

Faget sign

Michigan

tick bite

doxycycline

serology

typhoidal tularemia

Tularemia

Francisella tularensis

Ulcero-Glandular Disease

Fever of Unknown Origin

Tick Bite