SHM Converge Scientific Abstract ePoster Gallery-Twists, Turns, and Tularemia: Unmasking the Unusual

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This case describes a 55-year-old man with 10 days of progressive weakness, malaise, and intermittent fevers after recent work mowing grass and spraying rodenticides on a rural farm. He initially received methylprednisolone and amoxicillin without improvement. On exam, he had an eschar on the left clavicle with surrounding erythema and painful left axillary lymphadenopathy.<br /><br />Laboratory studies showed elevated inflammatory markers and mild abnormalities including anemia, kidney dysfunction, and elevated AST/ALT. A broad infectious, autoimmune, and hematologic workup was unrevealing. CT imaging showed enlarged left axillary and supraclavicular lymph nodes, and biopsy revealed a necrotic but non-malignant lymph node.<br /><br />Ulceroglandular tularemia was suspected after positive Francisella tularensis IgG testing and the patient’s clinical improvement with doxycycline. Diagnosis was then confirmed by CDC immunohistochemical staining, which was diffusely positive for F. tularensis.<br /><br />The report emphasizes that although tularemia is uncommon, it should be considered in patients with compatible exposure histories, especially those involving rural settings or contact with animal-associated materials. Careful history-taking and attention to lesion pattern and lymphadenopathy are critical for identifying rare infections and directing appropriate testing and treatment.

Asset Subtitle

Mir Y. Ali

Meta Tag

Author List Corey Shy, Mir Y. Ali, Rachel Bardowell

Category Clinical Vignettes

Concept Tularemia

Concept Ulcero-Glandular Disease

Concept Eschar

Concept Lymphadenopathy

Concept Fever

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Mir Y. Ali

Track Adult

Keywords

tularemia

Francisella tularensis

ulceroglandular tularemia

eschar

axillary lymphadenopathy

rural farm exposure

rodenticide exposure

doxycycline treatment

lymph node biopsy

infectious disease diagnosis

Tularemia

Ulcero-Glandular Disease

Eschar

Lymphadenopathy

Fever