Anamnesis:
A patient born in 1979 consulted our ENT-University hospital with a right sided cervical
lymphadenopathy. Four week prior he was treated for a right sided Conjunctivitis.
Findings:
The patient presented three fluctuant and painful right sided cervical masses, a light
weakness of the buccal branch of the facial nerve and a normal serology.
Diagnosis:
Abundant purulent secretion was drained intraoperatively. The microbiological and
pathological findings did not show any remarks. The PCR evidenced Fracisella tularensis.
Therapy and course of the case:
The patient received Ciprofloxacin and four weeks later Doxycyclin because of clinical
suspicion of relapse.
Discussion:
Tularemia is a rather rare zoonosis of the northern hemisphere with a rising incidence
in Germany. This gram negative, immobile, aerob and intracellular bacteria infects
small mammals (rabbits), arthropods (deer flies) and also birds and amphibians.
Contact with contaminated water or infectious animal materials, ingestion of uncooked
meat or arthropod stings are all possible ways a human can get infected. Aside from
flu-like symptoms, patients can present wide symptoms depending on the portal of entry.
Our patient showed an oculoglandular infection with involvement of the right eye (conjunctivitis
with eye lid edema) and the posterior development of a lymphadenopathy.
The early onset of antibiotics has great importance because untreated it can lead
to death in 60% of the cases.
