An unusual cause of a necrotic bullous skin lesion: a case report.
Katharina Knapp, Stephanie Holzer, Marius Schlienger
✦ AI-curated · Sources linked
Case in brief
A man in his 30s presented with a necrotic bullous lesion on his right palm and ipsilateral lymphadenopathy after contact with a hare carcass in Canada. Initial treatment with a cephalosporin was ineffective. PCR confirmed tularaemia, leading to a switch to ciprofloxacin after doxycycline was discontinued due to side effects. The lesion and symptoms resolved rapidly with ciprofloxacin.
What made this case unusual
The case illustrates ulceroglandular tularaemia presenting as a necrotic bullous skin lesion, which is atypical and highlights the need for awareness of this zoonotic infection in returning travelers.
Diagnostic / clinical pearl
Clinicians should consider tularaemia in patients with necrotic skin lesions and lymphadenopathy, especially following exposure to potential zoonotic sources.
Why it matters
This case underscores the importance of a detailed exposure history and the need for appropriate diagnostic testing when standard treatments fail.