‘Unique does not mean impossible: infant presenting with complicated course of ulceroglandular tularemia.’

Tularemia is a disease caused by Francisella tularensis—gram-negative coccobacillus. The ulceroglandular type characterized by skin ulcers and painful regional adenopathy is recognized as the most common. A 1-year-old patient was admitted with severe normocytic anemia, high fever and hepatosplenomegaly. A nonspecific lesion in the axillary region with a homogenous nodal reaction was found, combined with a history of a tick-bite in the pectoral muscle. Primary differentiation included leukemia, lymphoma, mononucleosis, borrelial lymphoma and simple abscess. All of the above were excluded. A further search for diagnosis focused on tick-borne diseases: TIBOLa or anaplasmosis. The ulceroglandular tularemia was eventually confirmed serologically. Besides the fact that tularemia is a rare diagnosis nowadays, it is still necessary to include this disease in the differentiation of a nonresolving tick-bite abscess with lymphadenopathy. Diagnostic vigilance is the key to effective treatment because other obvious symptoms such as severe anemia might delay the diagnosis.