Eschar in a Belgian traveler returning from Central Europe

Abstract Background: Tularemia is a zoonotic infection caused by Francisella tularensis, an aerobic, facultative intracellular coccobacillus, encountered especially in the Northern hemisphere. F. tularensis is a pathogen of humans and hundreds of animal species. Patients and methods: A Belgian traveler returning from an adventurous vacation in Central Europe presents fever, flu-like symptoms, a skin ulcer with a necrotic center resembling an eschar on the left thigh and painful left inguinal lymphadenopathy. An enzyme linked immunosorbent assay developed by the National Reference Laboratory for Tularemia, Sciensano, Belgium, detected elevated Ig G antibodies against F. tularensis, while the rest of the serologies were negative. Results: A highly likely case of ulceroglandular tularemia is described and the differential diagnosis is discussed. Conclusion: The incidence of tularemia has been increasing throughout Europe in recent years. Physicians should be aware of this disease, its diversity of reservoirs, transmission routes and clinical presentations.