Typhoidal tularemia with pancytopenia and pericarditis in a georgian adolescent

We report a rare case of typhoidal tularemia in an 18-year-old male from Kvemo Kartli, southern Georgia. The patient presented with a two-week history of high-grade fever, severe malaise, anorexia, and laboratory evidence of pancytopenia with hypoglycemia. The clinical course was complicated by pericarditis. Hematologic malignancy was initially suspected, but bone marrow aspiration revealed no blasts or dysplasia. Serologic testing confirmed Francisella tularensis infection. The patient responded to targeted antimicrobial therapy with full recovery. This case highlights the importance of considering tularemia in the differential diagnosis of febrile illnesses with cytopenia in endemic rural settings. Although tularemia is considered rare in many parts of the world, Georgia and neighboring regions have reported sporadic outbreaks, particularly in rural areas with close human-animal interactions. The typhoidal form is especially challenging to diagnose due to the absence of localized lesions, often mimicking other systemic febrile illnesses such as brucellosis, typhoid fever, or hematologic disorders. Early recognition is critical, as delayed treatment can result in severe complications, including multiorgan involvement, cardiovascular manifestations, and hematologic abnormalities. Reporting atypical presentations contributes to a better understanding of the disease spectrum and aids clinicians in endemic areas to consider tularemia even when classical signs are absent.