title: [Localized inflammatory alopecia of the scalp: an unusual presentation of tularemia].
abstract: BACKGROUND
  Tularaemia is a rare arthropod-borne zoonotic infection with 20 to 70 new cases being seen each year in France. Cutaneous ulceration and regional lymphadenopathy are the classical dermatological signs. Diagnosis of atypical forms is more complex.
  
  
  METHODS
  A 48-year-old woman was admitted for an erythematous papular alopecic lesion of the scalp accompanied by fever, chills and cervical lymphadenopathy. Initial antibiotic therapy for 20 days with amoxicillin clavulanate was ineffective. The patient's history included an episode of hunting in the forest three days before the onset of signs. Finally, serology led to the diagnosis of tularaemia. Combined levofloxacin and doxycycline resulted in regression of the scalp lesion and lymph node disorder.
  
  
  CONCLUSIONS
  The existence of alopecia and location on the scalp did not initially suggest a diagnosis of tularaemia to us. The clinical presentation was highly suggestive of impetigo with satellite lymphadenopathies. However, resistance to antibiotics and the absence of inflammation militated against this diagnosis, and other possible diagnoses such as a tick-borne lymphadenopathy (TIBOLA), borreliosis and tularaemia were discussed. The most common clinical presentation of tularaemia is ulceroglandular tularaemia, which predominates in 80% of cases. The inoculation chancre at the point of initial infection is most often located in the upper limbs.
  
  
  CONCLUSIONS
  An inflammatory plaque on the scalp with alopecia may reveal tularaemia, a potentially fatal disease resulting from inoculation.
authors.affiliation: Service de dermatologie, hôpital Porte-Madeleine, CHR d'Orléans, 1 rue Porte-Madeleine, Orléans cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Berton
authors.forename: H
authors.initials: H
authors.lastname: Nojavan
authors.forename: G
authors.initials: G
authors.lastname: Bens
authors.forename: E
authors.initials: E
authors.lastname: Estève
mesh_terms: D000505:Alopecia / Q000188:drug therapy / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008206:Lymphatic Diseases / Q000382:microbiology; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D012535:Scalp; D017444:Skin Diseases, Papulosquamous / Q000188:drug therapy / Q000382:microbiology; D014406:Tularemia / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin