title: A rare cause of abdominal lymphadenopathy--tularemia: report of two pediatric cases.
abstract: Tularemia caused by Francisella tularensis occurs worldwide in the northern hemisphere, with great variation in geographic and temporal occurrence. It generally presents as an acute febrile disease with the major clinical presentations including the six classic forms of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic. In contrast to European countries, where the ulceroglandular form is more prominent, the oropharyngeal form is the most common presentation in Turkey. We present rare cases of oropharyngeal tularemia in a 16-year-old boy and nine-year-old girl. To the best of our knowledge, these are the firstly described abdominal lymphadenopathy cases from Turkey. The second case was admitted with erythema nodosum, and abdominal lymphadenopathy was detected during the investigation. Excisional lymph node biopsy revealed abdominal tularemia. It is necessary to consider tularemia in the differential diagnosis of abdominal lymphadenopathy in tularemia regions. We also conclude that oropharyngeal tularemia can cause lymphadenopathy in any part of the gastrointestinal tract.
authors.affiliation: Department of Pediatric Infectious Diseases Refik Saydam National Public Health Agency, Ankara, Turkey.
authors.forename: Belgin
authors.initials: B
authors.lastname: Gülhan
authors.forename: Hasan
authors.initials: H
authors.lastname: Tezer
authors.forename: Saliha
authors.initials: S
authors.lastname: Kanık-Yüksek
authors.forename: Selçuk
authors.initials: S
authors.lastname: Kılıç
authors.forename: Emrah
authors.initials: E
authors.lastname: Senel
mesh_terms: D034841:Abdominal Cavity / Q000382:microbiology*; D001706:Biopsy; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification*; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D014406:Tularemia / Q000150:complications* / Q000175:diagnosis