title: Tularemia--an unusual cause of a solitary pulmonary nodule in the post-transplant setting.
abstract: We report a case of tularemia presenting as a solitary pulmonary nodule following syngeneic PBSC transplant. Seven months after undergoing a syngeneic PBSC transplant for AML, our patient presented with fever without localizing signs. Chest X-ray revealed a solitary pulmonary nodule. Culture of a CT guided needle aspiration revealed Francisella tularensis. The patient was successfully treated with ciprofloxacin. His fever resolved and clearance of the nodule was documented on a CT scan 2 months after diagnosis and initiation of treatment. To our knowledge, this is the only reported case of tularemia occurring in the post-transplant setting. The possible relationship between transplant-induced immune dysfunction and the occurrence of this rare infection is discussed.
authors.affiliation: Washington University School of Medicine, Department of Internal Medicine, St Louis, MO 63110, USA.
authors.forename: M
authors.initials: M
authors.lastname: Naughton
authors.forename: R
authors.initials: R
authors.lastname: Brown
authors.forename: D
authors.initials: D
authors.lastname: Adkins
authors.forename: J
authors.initials: J
authors.lastname: DiPersio
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D005604:Francisella tularensis / Q000302:isolation & purification*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014184:Transplantation, Homologous; D014406:Tularemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin