The authors declare that they have no competing interests.
PF, GMT, FG and SI drafted the manuscript and were responsible for clinical care of the patients. RG drafted the manuscript and performed the pathological work up. HF drafted the manuscript and provided microbiological input. All authors read and approved the final manuscript.
Pulmonary tularaemia is a very rare disease with only a small number of cases described in the literature. So far, to our knowledge, there exists no case report of pulmonary tularaemia where PET-CT scans and follow up CT scans are available.
We present four consecutive cases of pulmonary tularaemia. All patients suffered from non-specific symptoms. All patients were referred to our institution with strong suspicions of malignancy, particularly lung cancer.
Diagnosis of tularaemia was made by typical findings in the aspirate of EBUS guided fine needle aspiration (necrosis, epithelioid cell aggregation) and surgical biopsy respectively, and a positive serology. In three of the four cases, the diagnosis was confirmed by positive PCR results of the tissue. PET-CT scans obtained in all four cases were indistinguishable from lesions typically seen in patients suffering from lung cancer.
One of the four patients suffered from recurrence of the disease after antibiotic treatment; also this patient finally recovered after initiation of a second antibiotic regimen. One case became asymptomatic spontaneously, but this patient still received an antibiotic treatment.
In one case, a follow up CT scan was unchanged compared to the initial PET-CT scan; in all other cases, the lesions disappeared almost completely.
Symptoms of patients suffering from pulmonary tularaemia are non-specific and can be of prolonged character. PET-CT scans in these cases are indistinguishable from lung cancer. The diagnosis can be established when typical findings in EBUS guided fine needle aspirates or surgical biopsies are found in combination with a positive serology. In most cases the lesions disappear in follow up CT scans after clinically successful treatment.
Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30-year experience with 88 cases. Medicine (Baltimore). 1985;64(4):251–69. CrossRef
Scofield RH, Lopez EJ, McNabb SJ. Tularemia pneumonia in Oklahoma, 1982-1987. J Okla State Med Assoc. 1992;85(4):165–70. PubMed
Rimawi RH, Shah KB, Chowdhary RA, Cook PP. Hunting For Tularaemia- A Review of Cases in North Carolina. Zoonoses an Public Health. 2014; doi:10.1111/zph.12114.
Syrjala H, Kujala P, Myllyla V, Salminen A. Airborne transmission of tularemia in farmers. Scand J Infect Dis. 1985;17(4):371–5. PubMed
Hillerdal G, Kolbeck K, Jacobsson H. Pulmonary tularemia: rare disease that can be interpreted as lung cancer. Serology provides the correct diagnosis, as shown by case reports. Lakartidningen. 2013;110(27–28):1280–1. PubMed
- Pulmonary tularaemia: all that looks like cancer is not necessarily cancer – case report of four consecutive cases
Gabrielo Mauro Tini
- BioMed Central
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