Neck Mass: Tularemia Misdiagnosed as a Possible Malignancy

Tularemia is a zoonotic disease of the Northern Hemisphere caused by Francisella tularensis. Given its diverse animal reservoir and wide range of transmission modes, a thorough history of potential exposure is paramount. In the right context, fever combined with skin eruption and lymphadenopathy should raise the possibility of tularemia. Additionally, health care providers should be mindful that F. tularensis is a risk group 3 pathogen and a category A bioterrorism agent and presents a risk for laboratory personnel due to its aerosolization potential, low infectious dose, and fatality rate ranging from 2% to 60%.

Retrospective single chart review.

We describe a 65-year-old man with tularemia working as a bear-hunting guide whose management was delayed despite a fairly typical presentation due to lack of awareness regarding this disease. This case also demonstrates the need for safer referral practices and improved communications with the laboratory to ensure personnel are taking the appropriate measures while handling patient samples to avoid potentially serious consequences.

The diagnosis was confirmed from a neck mass biopsy and the patient made a complete recovery with appropriate antibiotic treatment.