[A tularemia mimicking lymphoma].

Area of Science:

• Internal Medicine
• Infectious Diseases
• Medical Diagnostics

Background:

• Adenopathies (enlarged lymph nodes) are common in internal medicine, often requiring investigation.
• Granulomatous inflammation in lymph nodes suggests various infectious or non-infectious causes.
• Differential diagnoses for granulomatous adenopathies include lymphoma, sarcoidosis, tuberculosis, and tularemia.

Observation:

• A 54-year-old presented with persistent fever, night sweats, and cough unresponsive to antibiotics.
• Imaging revealed hypermetabolic hilar and mediastinal adenopathies and pulmonary nodules.
• Polymerase chain reaction (PCR) on lymph node biopsy and serology confirmed tularemia.

Findings:

• Tularemia should be considered in patients with fever, night sweats, malaise, and mediastinal adenopathies.
• Diagnostic confirmation relies on combining ganglionic biopsy with molecular biology (PCR) and serological tests.
• The patient experienced a favorable outcome following appropriate antibiotic therapy.

Implications:

• Early and accurate diagnosis of tularemia is crucial for timely treatment and improved patient outcomes.
• Integrating molecular diagnostics and serology enhances the identification of this often-overlooked infection.
• This case highlights the importance of considering tularemia in the differential diagnosis of granulomatous adenopathies.