A Case of Glandular Tularemia: NEJM
A 68-year-old man from Missouri presented to the primary care clinic with a history of 1 week of fever followed by 2 months of progressive, painful swelling on the right side of his neck.

Approximately 2 days before the onset of the patient’s symptoms, his outdoor cat died from a subacute illness; a veterinarian had diagnosed feline leukemia without laboratory testing, and the cat had been treated with prednisone, which the patient administered. The patient’s physical examination revealed three erythematous, tender lymph nodes. The remainder of the physical examination was normal.

Serologic testing with IgM antibody was positive for Francisella tularensis (titer, 1:1280). A diagnosis of glandular tularemia was made. Glandular tularemia is the second most common manifestation of tularemia after the ulceroglandular form.

Because culture requires biosafety level 3 conditions, diagnosis is often confirmed serologically. Domestic cats can become infected through the consumption of infected prey and can transmit the bacteria to humans. The patient was treated with doxycycline for 4 weeks; the lesions improved within 5 days and resolved within 3 weeks.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1801531
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