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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Main Authors: S. Alkan, İ. Şahinoğlu, M. Serhat Şahinoğlu
Format: Article
Language:English
Published: Verduci Editore 2023-02-01
Series:Infectious Diseases and Tropical Medicine
Subjects:
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.
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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
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AT isahinoglu cervicallymphadenopathyinapatientreceivingantitnfatreatmentglandulartuberculosisororopharyngealtularemia
AT mserhatsahinoglu cervicallymphadenopathyinapatientreceivingantitnfatreatmentglandulartuberculosisororopharyngealtularemia