Ulceroglandular Tularemia
A 5-year-old girl presented to the pediatric emergency department with a 4-week history of painful swelling on both sides of her lower abdomen. Pets that she had regular contact with included a cat and a dog. Six weeks before presentation, her parents had noticed a tick buried in her umbilicus and had removed it with tweezers. Five days later, the patient had fever, loss of appetite, fatigue, and redness around the umbilicus (Panel A). These symptoms abated after 4 days. At the time of this presentation, examination showed marked inguinal lymphadenopathy on both sides (Panel B). Treatment with oral ciprofloxacin was initiated for suspected ulceroglandular tularemia. Serologic testing supported the diagnosis; the Francisella tularensis antibody titer was 1:1280. Two weeks after the completion of treatment, there was a reduction in the lymphadenopathy. After an additional 2 weeks, the swelling had completely resolved.
