A rare cause of granulomatous hepatitis: Tularemia


KOCABAŞ E. , ÖZGÜR GÜNDEŞLİOĞLU Ö. , Cil M. K. , ÇAY Ü. , DORAN F. , SOYUPAK S.

JOURNAL OF INFECTION AND PUBLIC HEALTH, cilt.13, ss.1003-1005, 2020 (SCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 13 Konu: 7
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1016/j.jiph.2019.12.007
  • Dergi Adı: JOURNAL OF INFECTION AND PUBLIC HEALTH
  • Sayfa Sayıları: ss.1003-1005

Özet

Tularemia is a zoonotic infection caused by Francisella tularensis. Tularemia has several clinical form in humans, including ulceroglandular, pneumonic, oropharyngeal, oculoglandular, and systemic (typhoidal). Tularemia may develop granulomatous and suppurative lesions, especially in the affected regional lymph nodes and various organs. Patients with hepatic involvement typically have elevated transaminase levels, hepatomegaly and rarely jaundice. Histologically, there are typically suppurative microabscesses with occasional surrounding macrophages. Rarely, hepatic granuloma can develop due to tularemia. We present a case of an 8 year-old male residing in a rural village in Turkey, who came to our hospital after having intermittent fever for four months and right upper abdominal pain for two months. Liver had a nodular appearance in liver imaging and liver biopsy were consistent with granulomatous hepatitis. The microagglutination test was positive for tularemia in the patient who was investigated for granulomatous hepatitis etiology. Symptoms and signs improved with tularemia treatment. We present a rare case of hepatic involvement of tularemia in a child. Clinicians should be suspicious of and evaluate for typhoidal tularemia in patients who present with prolonged fever and non-specific systemic symptoms, potentially with associated abdominal pain. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).