Histopathologic findings of tularemia lymphadenitis

Tularemia is a rare zoonotic infection most often acquired through exposure to infected animals, arthropods, or contaminated food or water. Diagnosis typically involves serologic or PCR testing, but histopathologic findings can be a clue to the diagnosis. Here, we present a case of inguinal lymphadenopathy in an adolescent patient with a history of multiple animal exposures and possible tick bite. Excisional lymph node biopsy showed necrotizing granulomatous inflammation, and the clinical history, histologic findings, and serologic results together led to the diagnosis of ulceroglandular tularemia. This report adds to the limited available literature on the histopathologic findings of tularemia lymphadenitis and discusses the importance of including this entity in the differential diagnosis for necrotizing granulomatous disease.