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Tularemi endemik bölgelerde farklı klinik tabloda görülebilir. İki ay önce boğaz ağrısı, ateş ve sonradan kilo kaybı, kesilmeyen öksürük, şikâyeti ile gelen bir bayan hasta. Yapılan kan biyokimyasında lökositoz (12.500/mm3), hemoglobin 9.9 gr/dl, sedimantasyon (103 mm/saatte), CRP (109 mg/l), ALT(61 I.U) ve AST (54 I.U) yüksekliği saptanmış. Hasta ampisillin tedavisine rağmen düzelme göstermemiş. Çekilen akciğer grafisinde hiler lenfadenomegali, lobular ve nodüler tutulum görülmüş ve bronkoskobide kitle saptanmıştır. Hastada, radyolojik olarak akciğer kanseri düşünülürken, şikâyetlerinin patates tarlasında çalıştıktan sonra geliştiği fark edilmiştir. Yapılan serolojide tularemi antikor testinin 1/1280 de pozitif gelmesi ile olgu sekonder pulmoner pnomoni olacağı düşünülmüştür. Hasta verilen üçlü antibiyotik tedavisi (streptomisin+doksisiklin+ciprofloksasin) ile tamamen düzelmiştir. Tulareminin nadir bir şekli olan pulmoner tutulum endemik bölgelerde akciğer kanseri ile karıştırılabilir. Olgu sunularak pnömonik tularemi literatürler eşliğinde gözden geçirildi.
Tularemia can be seen in different clinical pictures in endemic regions. A women who came with a complaint of sore throat, fever (380 C) and subsequent weight loss, unceasing cough, and complaints continuing for 2 months. In the blood samples, leukocytosis 12.500/mm3 hemoglobin 9.9 g/dl, sedimentation rate 103 mm/h, level of C-reactive protein 109 mg/l, alanine aminotransferase 61 i.u and aspartate aminotransferase 54 i.u were determined. The patient did not improve despite the ampicillin treatment. Hilar lymphadenomegaly, lobular and nodular involvement were seen on the X-ray chest and a mass was confirmed by bronchoscopy. It was noticed that the patient developed his complaints after working in the potato field while considering lung cancer radiologically. In the serology when the tularemia antibody test was positive at 1/1280, it was thought that the case would be secondary lung pneumonia. The patient recovered completely with the triple antibiotic treatment (streptomycin, doxycycline and ciprofloxacin) given. Pulmonary involvement, a rare form of tularemia, can be confused with lung cancer in endemic areas. The case was presented and pneumonic tularemia was reviewed with the literature.
Tularemia can be seen in different clinical pictures in endemic regions. A women who came with a complaint of sore throat, fever (380 C) and subsequent weight loss, unceasing cough, and complaints continuing for 2 months. In the blood samples, leukocytosis 12.500/mm3 hemoglobin 9.9 g/dl, sedimentation rate 103 mm/hour, level of C-reactive protein 109 mg/l, alanine aminotransferase 61 i.u and aspartate aminotransferase 54 i.u were determined. The patient did not improve despite the ampicillin treatment. Hilar lymphadenomegaly, lobular and nodular involvement were seen on the X-ray chest and a mass was confirmed by bronchoscopy. It was noticed that the patient developed his complaints after working in the potato field while considering lung cancer radiologically. In the serology when the tularemia antibody test was positive at 1/1280, it was thought that the case would be secondary pulmonary pneumonia. The patient recovered completely with the triple antibiotic treatment (streptomycin, doxycycline and ciprofloxacin) given. Pulmonary involvement, a rare form of tularemia, can be confused with lung cancer in endemic areas. The case was presented and pneumonic tularemia was reviewed with the literature.
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