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: docbelgin@yahoo.com
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.