Abstract
BackgroundCervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked. With an incidence of 120 cases in the United States of America (USA) and approximately 25 cases in Germany per year, infection with the pathogen Francisella tularensis is one of these rare diseases that can cause massive lymph node swellings and might even be fatal.Case presentationThe example of a healthy 67-year-old German woman who was treated at our university hospital presents a typical progression of a localized form of tularemia. The pathogen could be identified in a universal 16S ribosomal deoxyribonucleic acid (DNA) polymerase chain reaction. Pathogen-specific treatment with lymph node abscess incision, daily rinsing of the abscess cavity, and orally administered antibiotic therapy with doxycycline could cure our patient completely without any remaining complications.ConclusionIn patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment. Possible infections with atypical bacteria like Francisella tularensis should never be ignored. Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens.
Highlights
Cervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor
In patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment
Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens
Summary
Cervical lymph node swelling as a symptom appears quite often in old and young people. Long-lasting lymph node swellings or melted lymph node abscesses should be examined with the use of histological or microbiological analysis methods in order to initialize a specific therapy. The bacterial pathogens that cause lymph node enlargement are well known in the common clinical setting, an infection with uncommon pathogens should always be taken into consideration in order to start a specific therapy. One of these pathogens is infection with F. tularensis; F. tularensis is the bacteria that causes the disease tularemia and is commonly transmitted by wild animals.
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