A 65-Year-Old Groundskeeper With High Fever, Pulmonary Nodules, and Thoracic Lymphadenopathy.
A 65-year-old man with treated latent tuberculous infection presented with 1 week of fevers (up to 39.6°C), chills, headache, lightheadedness, and malaise. He reported a chronic, nonproductive cough without hemoptysis but denied other localizing symptoms, sick contacts, or recent travel. He lived in an urban area in eastern Colorado and owned one healthy dog but otherwise denied known animal exposures. He was a retired oil driller who had worked in southern Arizona, New Mexico, and northern Mexico (Sonora region). Other travel included 3 years in the early 1970s working as a military aircraft mechanic in Vietnam, Laos, and Thailand. Six weeks prior to admission, he began work as a groundskeeper on a golf course that had experienced recent flooding, using a riding mower and exposing himself to airborne dust and organic debris. He smoked a pipe daily for 30 years but quit 2 months prior to presentation, although he continued to smoke marijuana weekly. He denied intravenous drug use.
Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO.
Clayton L
CL
Foster
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Jessica
J
Badlam
Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO.
Mary Ann
MA
De Groote
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Medicine and Academic Affairs, National Jewish Health, Denver, CO; Department of Medicine, Denver Veterans Affairs Medical Center, Denver, CO. Electronic address: chane@njhealth.org.
Edward D
ED
Chan
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D005604:Francisella tularensis / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D000072281:Lymphadenopathy / Q000175:diagnosis / Q000209:etiology; D008297:Male; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis*; D012698:Serologic Tests / Q000379:methods; D013909:Thorax / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014406:Tularemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin