Tick-borne tularemia presenting as ulcerative lymphadenitis

In a patient with suppurative lymphadenitis who fails to respond to antibiotics routinely used for pyogenic adenitis, the diagnosis of tularemia should be considered if there is good evidence for recent tick or other insect exposure. A trial of streptomycin therapy may be indicated, pending culture and serology results, in any patient whose signs and symptoms strongly suggest this diagnosis.