SHM Converge Scientific Abstract ePoster Gallery-Tularemia Presenting as Fever of Unknown Etiology

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This case describes a 28-year-old immunosuppressed man with Crohn’s disease on infliximab who presented in early summer with four weeks of persistent fever of unknown origin. Extensive evaluation, including blood and urine cultures, CT imaging, and testing for common tick-borne, respiratory, meningitis, EBV, CMV, and West Nile infections, was negative. He initially received empiric antibiotics and prednisone without improvement.<br /><br />One week later, he developed sore throat and cervical lymphadenopathy. Neck CT showed necrotizing lymphadenopathy, and an open lymph node biopsy revealed extensive necrotizing granulomas. Tissue cultures grew gram-negative coccobacilli, later identified as Francisella tularensis. Serology for tularemia was positive for both IgM and IgG, confirming the diagnosis.<br /><br />The patient completed two weeks of ciprofloxacin and doxycycline with full resolution of symptoms. He did not recall a tick bite, but his work as a golf course manager involved frequent outdoor exposure, suggesting possible contact with an infected animal or an unrecognized tick exposure.<br /><br />The discussion highlights that tularemia is rare in North Dakota and can be difficult to diagnose because clinical features vary depending on the route of infection. This patient had the glandular form, a less common adult presentation. Tularemia should be considered in patients with prolonged fever and necrotizing lymphadenitis, especially when routine infectious workup is unrevealing and there is outdoor or animal exposure. Treatment options include gentamicin, ciprofloxacin, and doxycycline, with ciprofloxacin showing favorable outcomes in recent studies.

Asset Subtitle

Jackson Haug

Meta Tag

Author List Avish Nagpal, Jackson Haug, Nishita Gaba

Category Clinical Vignettes

Concept Tularemia

Concept Francisella tularensis

Concept Gentamicin

Concept Fever of Unknown Origin

Concept Glandular Tularemia

Distinguished Non-Finalist

Presenter Organization University of North Dakota

Presenting Author Jackson Haug

Track Adult

Keywords

tularemia

Francisella tularensis

necrotizing lymphadenitis

fever of unknown origin

immunosuppressed

Crohn's disease

infliximab

glandular tularemia

cervical lymphadenopathy

ciprofloxacin doxycycline

Tularemia

Francisella tularensis

Gentamicin

Fever of Unknown Origin

Glandular Tularemia