An atypical case of tularemia presented with pseudoptosis

Abstract

We report an unusual case of tularemia involving pseudoptosis associated with deterioration of the lymphatic drainage system extending from the upper eyelid to the preauricular lymph nodes. A 16-week pregnant patient was admitted with an absess on the neck, preauricular lymphadenopathy, and pseudoptosis on the left side. The micro-agglutination test was positive for Francisella tularensis antibody at a titer of 1/200. The absess was surgically drained and oral cefuroxime was given for 6 weeks. Two weeks after drainage, the pseudoptosis improved due to the recovery of lymphatic drainage system of the eyelid and remission of the absess on the neck. Our case report contributes to the medical literature on tularemia during pregnancy and informs healthcare professionals on the management of the infection in such cases.

Evaluation of Infections in Hospitalised Pregnant Women

“…Tularemia during pregnancy may lead to prematurity or fetal loss. However, healthy newborns who were not adversely affected by maternal tularemia have also been reported [26][27][28][29][30] . There is no consensus regarding the treatment of tularemia during pregnancy.…”

Treatment of Tularemia during pregnancy

“…Although tularemia in pregnancy has recently been increasingly reported [2][3][4][5], the number of pregnant women among the 393 patients with tularemia reported by Mengeloglu et al was not indicated. Unfortunately, even though it is vital for the pregnant woman and the fetus to receive the optimal medical treatment, there is not enough reported data on this subject.…”

“…Unfortunately, even though it is vital for the pregnant woman and the fetus to receive the optimal medical treatment, there is not enough reported data on this subject. We have recently published two cases on tularemia during pregnancy [4,5]. The first patient presented with a large abscess on the cervical area and pseudoptosis [4] and the second patient had an acute dacryocystitis with a large abscess [5].…”

“…We have recently published two cases on tularemia during pregnancy [4,5]. The first patient presented with a large abscess on the cervical area and pseudoptosis [4] and the second patient had an acute dacryocystitis with a large abscess [5]. They lived in central Anatolia, which is an endemic area for tularemia.…”

“…The abscess was surgically drained through an incision. The patient refused the aminoglycoside or quinolone treatment because of the potential side effects on the fetus; thus, the cefuroxime protocol (500 mg a day for 6 weeks) was administered [4]. The second patient, a 27-yearold woman with 18 weeks gestation, was referred to our hospital with purulent conjunctivitis and an abscess secondary to acute dacryocystitis caused by tularemia.…”