Unmasked: when a clinically malignant disease turns out infectious. A rare case of tularemia.
This article reports on a 62-year-old man, who presented with cervical mass and rather nonspecific symptoms. The medical history and clinical workup initially favored a malignant disease such as a carcinoma of unknown primary as the underlying cause. Eventually, the patient was diagnosed with a granulomatous lymphadenitis caused by Francisella tularensis subsp holarctica. Tularemia is a rare disease in Western Europe and can present in multiple ways encompassing almost asymptomatic infections and fatal disease. A rapid diagnosis is often hampered by nonspecific symptoms and the generally low prevalence and incidence of this disease in endemic countries. This case report also provides a comprehensive review of the literature on cervical tularemia and discusses the differential diagnoses.
University Hospital Heidelberg, Heidelberg, Germany.
Olcay Cem
OC
Bulut
Gerhard
G
Dyckhoff
Wolf
W
Splettstoesser
Johannes
J
Nemeth
Frederick
F
Klauschen
Roland
R
Penzel
Peter K
PK
Plinkert
Christian
C
Simon
Wilko
W
Weichert
Albrecht
A
Stenzinger
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D005604:Francisella tularensis / Q000235:genetics / Q000302:isolation & purification; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000556:secondary; D006801:Humans; D008199:Lymphadenitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009333:Neck; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis*; D016896:Treatment Outcome; D014406:Tularemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004318:Doxycycline