The Turkish Journal of Pediatrics 2014 , Vol 56 , Num 2
A Rare Cause of Abdominal Lymphadenopathy – Tularemia: Report of Two Pediatric Cases
Departments of 1Pediatric Infectious Diseases and 4Pediatric Surgery, Ankara Children’s Diseases Hematology-Oncology Training Hospital, 2Division of Pediatric Infectious Diseases, Department of Pediatrics, Gazi University Faculty of Medicine, and 3Department of Communicable Diseases Research, Bacterial Zoonoses and Reference Laboratory, Refik Saydam National Public Health Agency, Ankara, Turkey. E-mail: Tularemia caused by Francisella tularensis occurs worldwide in the northern hemisphere, with great variation in geographic and temporal occurrence. It generally presents as an acute febrile disease with the major clinical presentations including the six classic forms of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic. In contrast to European countries, where the ulceroglandular form is more prominent, the oropharyngeal form is the most common presentation in Turkey. We present rare cases of oropharyngeal tularemia in a 16-year-old boy and nine-year-old girl. To the best of our knowledge, these are the firstly described abdominal lymphadenopathy cases from Turkey. The second case was admitted with erythema nodosum, and abdominal lymphadenopathy was detected during the investigation. Excisional lymph node biopsy revealed abdominal tularemia. It is necessary to consider tularemia in the differential diagnosis of abdominal lymphadenopathy in tularemia regions. We also conclude that oropharyngeal tularemia can cause lymphadenopathy in any part of the gastrointestinal tract. Keywords : abdominal lymphadenopathy, tularemia, children.
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