[Mind the bat: Rare Infection as Lung Cancer Mimic - a Case Report]

A 63-year-old male patient presented with a 5-day history of fever and productive cough. His history revealed renovation work in an attic with exposure to dead bats. No improvement occurred under treatment with amoxicillin/clavulanic acid.

Chest CT demonstrated a lesion in the right upper lobe with mediastinal lymph node involvement, highly suspicious for lung carcinoma. Bronchoscopy, EBUS-TBNA, and thoracoscopic biopsy revealed inflammation without evidence of malignancy. PCR testing of the obtained tissue was positive for Francisella tularensis, subsequently confirmed by serology. The diagnosis was pulmonary tularemia.

Treatment consisted of gentamicin and doxycycline for 7 and 14 days, respectively. Following the initiation of antibiotic therapy, the patient's symptoms resolved.

As CT imaging is now widely available and findings of pulmonary tularemia closely resemble malignant processes, it must be considered as a differential diagnosis for lung cancer. A detailed history including exposure risks is essential to avoid unnecessary invasive diagnostic procedures.