Abstract Introduction Tularemia is a rare Zoonotic disease, that presents as an acute febrile illness, that is usually transmitted through direct contact with infected small animals. Tularemia is a highly infectious bacteria, that has a varied clinical presentation based on the mode of exposure. Tularemia generally presents with nonspecific symptoms, which tend to include fever, chills and malaise, anywhere from 1-21 days after exposure. Pulmonary tularemia is exceedingly rare, with few case reports documented. Diagnosis with EUS-FNA is an uncommon method for the diagnosis. Case Presentation Our patient is a 47 y.o African American female, who presented with multiple ED visits with symptoms of high fever, chills, headache and fatigue. Infectious work up thus far had been negative. Patient was found to have mediastinal lymphadenopathy, suspicious for lymphoma or metastatic disease. Patient additionally had multiple pulmonary nodules. PET scan was notable for right supraclavicular, thoracic, and upper abdominal lymph nodes, along with FDG avid splenic parenchyma concerning for active neoplasm. The patient underwent an EBUS-FNA which was negative for malignancy but showed inflammation and necrotizing granulomatous lymphadenitis. Bacterial culture was positive for Francisella Tularensis, with an additional positive serum Francisella tularensis antibody which confirmed the diagnosis. Patient was treated with a 10 day course of ciprofloxacin, with some improvement in her symptoms. Discussion Tularemia can be a delayed and challenging diagnosis to make. The use of EBUS-FNA, while not standard, has been an effective method for the diagnosis of Tularemia. Tularemia is a rare disease, most commonly seen in young to middle aged Caucasian males. Presentations in less common patient populations, can make diagnosing this disease even more difficult. Clinicians should maintain a high index of suspicion for tularemia in patients with granulomatous mediastinal lymphadenitis, even when malignancy is initially suspected. This case underscores the diagnostic versatility of EBUS-FNA in identifying infectious causes of mediastinal lymphadenopathy. This abstract is funded by: None
Norgbe et al. (Fri,) studied this question.