Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia?
BACKGROUND: Tularemia is a global anthroponotic disease that is endemic in some regions of Turkey, and it is carried by small rodents (hares) and arthropods (ticks, horseflies). Tularemia is caused by the Francisella tularensis bacteria, which is a facultatively intracellular Gram-negative bacillus....
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Format: | Article |
Language: | English |
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Verduci Editore
2023-02-01
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Series: | Infectious Diseases and Tropical Medicine |
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Online Access: | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2023/02/e1072.pdf |
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author | S. Alkan İ. Şahinoğlu M. Serhat Şahinoğlu |
author_facet | S. Alkan İ. Şahinoğlu M. Serhat Şahinoğlu |
author_sort | S. Alkan |
collection | DOAJ |
description | BACKGROUND: Tularemia is a global anthroponotic disease that is endemic in some regions of Turkey, and it is carried by small rodents (hares) and arthropods (ticks, horseflies). Tularemia is caused by the Francisella tularensis bacteria, which is a facultatively intracellular Gram-negative bacillus.
CASE PRESENTATION: Herein, we present a case of oropharyngeal tularemia living in an endemic region of Turkey. The patient was 64 years old, had rheumatoid arthritis, and had been taking anti-TNF (adalimumab) in combination with methotrexate for about a year. She had swelling in her neck. She also had a sore throat and recurrent mouth ulcers. Her vital signs showed no abnormality; she had no fever, and physical examination only revealed hyperemia in the left cervical region and an enlarged painful lymph node. Significant tularemia serological titers supported the diagnosis, with contaminated water consumption being the most likely transmission route. Streptomycin (15 mg/kg/day, intramuscular) was given for 10 days. The patient healed completely without any complications. Six months later, there had been no recurrence.
CONCLUSIONS: Particularly in endemic regions, tularemia should be considered in the differential diagnosis of lymphadenopathy with necrotic granuloma in patients receiving anti-TNF α treatment. |
first_indexed | 2024-03-08T17:34:12Z |
format | Article |
id | doaj.art-f5159dbdf3224f338b4c8333b5e2878c |
institution | Directory Open Access Journal |
issn | 2379-4054 |
language | English |
last_indexed | 2024-03-08T17:34:12Z |
publishDate | 2023-02-01 |
publisher | Verduci Editore |
record_format | Article |
series | Infectious Diseases and Tropical Medicine |
spelling | doaj.art-f5159dbdf3224f338b4c8333b5e2878c2024-01-02T13:27:41ZengVerduci EditoreInfectious Diseases and Tropical Medicine2379-40542023-02-01910.32113/idtm_20232_10721072Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia?S. Alkan0İ. Şahinoğlu1M. Serhat Şahinoğlu2Department of Infection Diseases, Canakkale Onsekiz Mart University, Canakkale, TurkeyDepartment of Rheumatology, Manisa Celal Bayar University, Manisa, TurkeyDepartment of Infectious Diseases and Clinical Microbiology, Manisa City Hospital, Manisa, TurkeyBACKGROUND: Tularemia is a global anthroponotic disease that is endemic in some regions of Turkey, and it is carried by small rodents (hares) and arthropods (ticks, horseflies). Tularemia is caused by the Francisella tularensis bacteria, which is a facultatively intracellular Gram-negative bacillus. CASE PRESENTATION: Herein, we present a case of oropharyngeal tularemia living in an endemic region of Turkey. The patient was 64 years old, had rheumatoid arthritis, and had been taking anti-TNF (adalimumab) in combination with methotrexate for about a year. She had swelling in her neck. She also had a sore throat and recurrent mouth ulcers. Her vital signs showed no abnormality; she had no fever, and physical examination only revealed hyperemia in the left cervical region and an enlarged painful lymph node. Significant tularemia serological titers supported the diagnosis, with contaminated water consumption being the most likely transmission route. Streptomycin (15 mg/kg/day, intramuscular) was given for 10 days. The patient healed completely without any complications. Six months later, there had been no recurrence. CONCLUSIONS: Particularly in endemic regions, tularemia should be considered in the differential diagnosis of lymphadenopathy with necrotic granuloma in patients receiving anti-TNF α treatment.https://www.infectiousjournal.com/wp-content/uploads/sites/6/2023/02/e1072.pdffrancisella tularensisgranulomatous lymphadenitislymphadenitisoropharyngeal tularemia |
spellingShingle | S. Alkan İ. Şahinoğlu M. Serhat Şahinoğlu Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? Infectious Diseases and Tropical Medicine francisella tularensis granulomatous lymphadenitis lymphadenitis oropharyngeal tularemia |
title | Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? |
title_full | Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? |
title_fullStr | Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? |
title_full_unstemmed | Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? |
title_short | Cervical lymphadenopathy in a patient receiving anti-TNF a treatment: glandular tuberculosis or oropharyngeal tularemia? |
title_sort | cervical lymphadenopathy in a patient receiving anti tnf a treatment glandular tuberculosis or oropharyngeal tularemia |
topic | francisella tularensis granulomatous lymphadenitis lymphadenitis oropharyngeal tularemia |
url | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2023/02/e1072.pdf |
work_keys_str_mv | AT salkan cervicallymphadenopathyinapatientreceivingantitnfatreatmentglandulartuberculosisororopharyngealtularemia AT isahinoglu cervicallymphadenopathyinapatientreceivingantitnfatreatmentglandulartuberculosisororopharyngealtularemia AT mserhatsahinoglu cervicallymphadenopathyinapatientreceivingantitnfatreatmentglandulartuberculosisororopharyngealtularemia |