Pulmonary tularaemia: all that looks like cancer is not necessarily cancer – case report of four consecutive cases

Table 1 Findings, treatment and clinical course of four patients suffering from pulmonary tularemia

Patient	No 1	No 2	No 3	No 4
Lead symptoms	Cough, weight loss, night sweat	Fatigue, head ace, fever	Weight loss, head ace, fever	Cough, fever
Date of diagnosis	Jan 12	Sep 12	Oct 2012	Oct 2012
Duration of symptoms before/after start of therapy (weeks)	14/NA (spontanous recovery)	12/6	9/12	2/2
Agglutination titer for F. tularensis	1:320	1:5120	1:320	1:640
White-cell count (per mm3)/CRP (mg/liter) at first presentation in our institution	4.2/6	11.4/87	5.1/83	6/<3
Nested PCR tissue for F. tularensis	positive	positive	not done	positive
EBUS-TBNA	necrosis, epithelioid cell aggregation	necrosis, epithelioid cell aggregation	necrosis, epithelioid cell aggregation	normal lymphocytes
Surgical biopsy	yes	not done	not done	yes
Probable vector	rabbit feces	tick	unknown	unknown
Treatment	1.doxycyclin	ciprofloxacin	ciprofloxacin	ciprofloxacin
Treatment	2.garamycin/cipro-floxacin	ciprofloxacin	ciprofloxacin	ciprofloxacin
Course	recurrence after doxycyclin	remission	remission	remission
Length of follow up (months)	27	18	16	16
Initial CT scan findings	Hilar mass, enlarged lymph nodes, pulmonary nodule	Pulmonary nodules, enlarged lymph nodes	Hilar mass, enlarged lymph nodes	Mass in the middle, enlarged lymph nodes
CT scan findings after completed treatment	Residual lesion	Small residual parenchymal scar	unchanged	Small residual hilar scar

CRP: C-reactive protein, EBUS-TBNA: endobronchial ultrasound guided transbronchial needle aspiration, CT: computed tomography, PCR: polymerase chain reaction; NA: not applicable.

ISSN: 1471-2466