title: Eschar and neck lymphadenopathy caused by Francisella tularensis after a tick bite: a case report.
abstract: BACKGROUND
  In 25 to 35% of cases, the aetiological agent of scalp eschar and neck lymphadenopathy after a tick bite remains undetermined. To date, Rickettsia slovaca, Rickettsia raoultii and more recently Bartonella henselae have been associated with this syndrome.
  
  
  METHODS
  A four-year-old Caucasian boy was admitted to hospital with fever, vomiting and abdominal pain. On physical examination, an inflammatory and suppurating eschar was seen on the scalp, with multiple enlarged cervical lymph nodes on both sides. Although no tick was found in this scalp lesion, a diagnosis of tick-borne lymphadenopathy was suggested, and explored by serology testing and polymerase chain reaction of a biopsy from the eschar. Francisella tularensis DNA was found in the skin biopsy and the serology showed titres consistent with tularaemia.
  
  
  CONCLUSIONS
  This is, to the best of our knowledge, the first reported case of scalp eschar and neck lymphadenopathy after tick bite infection caused by F. tularensis.
authors.affiliation: Faculté de Médecine et de Pharmacie, URMITE UMR 6236, CNRS-IRD, 27 Bd Jean Moulin 13385 Marseille cedex 05, France. didier.raoult@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Edouard
authors.forename: Khira
authors.initials: K
authors.lastname: Gonin
authors.forename: Yves
authors.initials: Y
authors.lastname: Turc
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Angelakis
authors.forename: Cristina
authors.initials: C
authors.lastname: Socolovschi
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult