Case 211. Tularemia (35 y-o M)
    Biopsied supraclavicular lymph node in an animal seller, presenting high fever and fistule-forming nodal swelling    
Key words : Francisella tularensis, tularemia, suppurative granuloma
Francisella tularensis causes suppurative granuloma in the lymph node (HE). Differential points from cat scratch disease are as follows: Necrotic areas are large and fused, epithelioid cells show a palisade arrangement and Langhans giant cells are common.   Higher power view of suppurative granuloma (HE). It is difficult to identify pathogens within the lesion. The pathogens are transmitted by rabbit, squirrel, rat or tick. Transmission through aerosol may occur in the laboratory, so that F. tularensis is nominated as a bioterrorist.
Reference case 211A
Tularemia-like lesions in an 85 y-o male (resident in Shizuoka). Painless ulcer of the neck skin was continuous to the underlying lymph node (HE, low power). Tuberculin reaction was negative and no lung lesion was seen. However, the patient had no history of contact with animals, and the serologic test against F. tularensis antigen was negative.
  Reference case 211A
Suppurative granulomas resemble tularemia histologically (HE). Langhans-type giant cells are evident. The final diagnosis of this case is unclear. Tuberculin reaction was negative. The clinical course was not aggressive. In Japan, tularemia is seen only in the northern part, but not in Shizuoka.