An 8-month-old infant with hepatic tularemia: a case report.
Anais Letonia, Jennifer Frühwirth, Herbert Kurz et al.
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Case in brief
An 8-month-old infant developed fever up to 40 °C, vomiting, and diarrhea after a nuchal tick bite with local wound infection. Fever persisted despite anti-inflammatory medication and antibiotics. Ultrasound showed multiple hypoechoic splenic lesions and upper abdominal lymphadenopathy; a lymphadenitis panel was positive for Francisella tularensis. Subsequent imaging also showed hepatic lesions, interpreted as tularemia-related granulomas. The infant received ciprofloxacin and was discharged on oral antibiotics 5 days after diagnosis. Serology supported recent infection, and after a further 2 weeks of antibiotic treatment, the hepatic and splenic lesions had regressed significantly.
What made this case unusual
The hepatic granulomas appeared on repeat ultrasound alongside splenic lesions in an infant with tularemia, initially suspected to have septic dissemination from the tick bite.
Diagnostic / clinical pearl
In an infant with persistent fever after a tick bite and splenic lesions, tularemia should be considered; repeat imaging may reveal hepatic granulomas.