Case 211. Tularemia (35 y-o M)

　 　 　 　
　 Biopsied supraclavicular lymph node in an animal seller, presenting high fever and fistule-forming nodal swelling 　
　 　 　 　

　

 　 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.