Lymph node abscess caused by Francisella tularensis– a rare
Cervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked.

A 67-year-old German woman without any pre-existing illnesses was referred from Ear, Nose, and Throat (ENT) department with an intraoral laceration in the region of her upper left wisdom tooth. She felt faint and had quite high fever. Her leukocytes were not increased (5.88 × 103/μl), whereas a massive elevation of C-reactive protein (224 mg/l) could be detected. Therapy consisting of intravenously administered antibiotic treatment with penicillin V 10 mega units once daily was started. In addition to that the impacted tooth was extracted the same day.

This treatment regimen did not significantly improve her health status. She started to get higher fever accompanied by an increase in cervical lymph node swelling. At 25 days after tooth removal, the size of her lymph nodes increased to a diameter of approximately 30 mm. She was hospitalized for a repeated intravenous treatment with antibiotics consisting of penicillin V 10 mega units once daily combined with metronidazole 0.5 g twice daily again

Source: Journal of Medical Case Reports

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