[Mediastinal lymphadenopathy: Do not forget tularemia!]

Area of Science:

• Infectious Diseases
• Pulmonology
• Medical Microbiology

Background:

• Mediastinal lymphadenopathy is a common referral reason for pulmonologists.
• While common causes like malignancy and sarcoidosis are frequent, unusual etiologies require consideration.
• Rare infections can present as hypermetabolic mediastinal lymphadenopathy.

Purpose of the Study:

• To highlight tularemia as an unusual cause of mediastinal lymphadenopathy.
• To emphasize the importance of clinical context in diagnosing tularemia.
• To report successful treatment outcomes for tularemia presenting as lymphadenopathy.

Main Methods:

• Case series of three young patients with hypermetabolic mediastinal lymphadenopathy.
• Evaluation of patient history for potential exposure (tick bites, animal contact).
• Diagnostic confirmation via Francisella tularensis serology.

Main Results:

• All three patients diagnosed with tularemia.
• Symptoms included fever and diffuse myalgia, with non-specific presentations.
• Favorable clinical and radiological evolution observed after antibiotic treatment.

Conclusions:

• Tularemia should be considered in cases of lymphadenopathy following tick bites or animal exposure.
• Early diagnosis based on serology and clinical context is crucial.
• Prompt antibiotic therapy (ciprofloxacin or doxycycline) is effective.