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[Pleuropulmonary tularemia in a 63-year-old hunter in Germany].

HISTORY
A 63-year-old amateur hunter without relevant preexisting diseases presented with cough lasting for 4 weeks and B symptoms.


INVESTIGATIONS
Radiography and ultrasonography showed a left-sided pleural effusion. Laboratory markers of infection were in normal range. A thoracocentesis was performed for diagnostic purposes.


TREATMENT AND COURSE
Culture of Francisella tularensis spp. holarctica from pleural fluid led to the diagnosis of tularemia with unusual manifestation as an isolated one-sided pleuritis, confirmed by highly positive serology. The patient fully recovered on oral treatment with doxycycline.


CONCLUSION
Due to its low prevalence in Germany and multiple possible clinical manifestations, the diagnosis of tularemia can be difficult. Hence, it is decisive to include tularemia in the differential diagnosis, especially if anamnestic or epidemiological evidence exists.