[A patient with a fever and an eschar caused by tularemia]

A 38-year-old man presented at the first-aid department complaining of fever, general malaise and a painful left groin. The complaints had started shortly after an active holiday in Finland. Physical examination showed enlarged left sided inguinal lymph nodes and a marked eschar on the left lower leg. In terms of differential diagnosis a Rickettsia or a tularemia infection were considered. The pathogen for tularemia, Francisella tularensis subspecies holarctica, was isolated in wound discharge from the patient. Serology also indicated infection with F. tularensis. The patient was treated at home with oral doxycycline and recovered fully in a few days. In patients presenting with an eschar, rickettsiosis is often the first and only disease that is considered. This case report clearly emphasizes that a differential diagnosis of an eschar can be made and that this includes tularemia.