Abstract

A 66-year-old woman was admitted to our clinic with fever and swelling in her neck. She was unresponsive to empiric antibiotic treatment with cefuroxime axetil given for upper respiratory tract infection in a different center. She reported a tick bite on her neck one week before development of symptoms. On physical examination, there was an ulcerative nodular lesion on posterior cervical region together with regional lymphadenopathy. A positive titer of 1/160 was detected by Francisella tularensis microagglutination test. Ulceroglandular form of tularemia was diagnosed and oral doxycycline 2×100 mg was started. She was discharged with cure after a treatment of two weeks. As this case exemplified, tularemia forms  other than oropharyngeal form which is most prevalent in Turkey can be encountered among patients with fever and lymphadenopathy in endemic areas.