[Pleuropulmonary tularemia in a 63-year-old hunter in Germany]. / Pleuropulmonale Tularämie bei einem 63-jährigen Jäger in Deutschland.

ABSTRACT

HISTORY A 63-year-old amateur hunter without relevant preexisting diseases presented with cough lasting for 4 weeks and B symptoms. INVESTIGATIONS Radiography and ultrasonography showed a left-sided pleural effusion. Laboratory markers of infection were in normal range. A thoracocentesis was performed for diagnostic purposes. TREATMENT AND COURSE Culture of Francisella tularensis spp. holarctica from pleural fluid led to the diagnosis of tularemia with unusual manifestation as an isolated one-sided pleuritis, confirmed by highly positive serology. The patient fully recovered on oral treatment with doxycycline. CONCLUSION: Due to its low prevalence in Germany and multiple possible clinical manifestations, the diagnosis of tularemia can be difficult. Hence, it is decisive to include tularemia in the differential diagnosis, especially if anamnestic or epidemiological evidence exists.