Unilateral acute dacryocystitis associated with oculoglandular tularemia: a case report

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Oculoglandular tularemia is a rare zoonotic infection caused by Francisella tularensis.
• It typically presents with fever, cervical lymphadenopathy, and purulent conjunctivitis.

Observation:

• This case describes a pregnant patient (18 weeks) with unilateral acute dacryocystitis and purulent conjunctivitis.
• Diagnosis was challenging due to difficulties in culturing Francisella tularensis, relying on serological tests (micro-agglutination) and PCR.

Findings:

• The patient tested positive for Francisella tularensis antibodies with a titer of 1/160.
• Treatment involved amoxicillin-clavulanic acid due to fetal side effects of other antibiotics.
• Surgical drainage of dacryocystitis was required twice, with a ciprofloxacin-impregnated sponge used in the second procedure to prevent relapse.

Implications:

• Acute dacryocystitis should be considered a potential, albeit rare, component of the oculoglandular syndrome.
• This case highlights the importance of considering tularemia in pregnant patients presenting with severe eye and lacrimal sac infections.
• Effective management requires a multidisciplinary approach, balancing maternal and fetal safety with infection control.