Combined pneumonia and glandular tularemia following a tick bite in an immunocompromised patient.

Francisella tularensis can cause a broad spectrum of clinical manifestations depending on the route of inoculation. In northeastern France, tick bites are a frequent route of transmission. Typically, vector-borne inoculation results in glandular or ulceroglandular forms, whereas aerosol exposure causes pulmonary forms. We report the case of a 72-year-old immunocompromised woman (rheumatoid arthritis treated with methotrexate) who developed pneumonia six days after a tick bite, diagnosed four weeks later with a glandular tularemia. Although Francisella tularensis was not isolated from the lungs, a diagnosis of pulmonary tularemia was suspected at the adenitis stage based on serology and Polymerase chain reaction testing performed on the affected lymph node. The patient was successfully treated by ciprofloxacin. This case underscores the possibility of pulmonary tularemia following tick bites and the fact that multiple clinical forms may coexist in the same patient. Physicians should consider tularemia in case of pneumonia, especially when suggestive factors such as tick exposure or adenitis are present.