# Oropharyngeal Tularemia: A Case From Rural Armenia Highlighting Diagnostic Challenges and Treatment Outcomes

## TL;DR

A case of oropharyngeal tularemia in rural Armenia highlights diagnostic difficulties and treatment outcomes.

## Contribution

This case study emphasizes the diagnostic challenges and treatment outcomes of tularemia in a rural setting.

## Key findings

- Tularemia was confirmed through serological tests despite initial misdiagnosis.
- Treatment with ciprofloxacin and doxycycline led to recovery after lymph node suppuration.

## Abstract

Tularemia, a life-threatening zoonotic infection caused by Francisella tularensis, is a significant public health concern. Diagnosis can be challenging due to nonspecific symptoms, including fever, tonsillitis, and lymphadenopathy. We present the case of a 48-year-old male from a rural area of the Tavush region admitted to our hospital, initially presenting with left-sided tonsillitis, followed by the development of enlarged lymph nodes in the neck and a mild fever. Despite initial treatment with amoxicillin, tularemia was confirmed through positive serological tests, including antibody titers of 1:400 by the volumetric agglutination method and elevated IgM (0.74) and IgG (0.51) levels by enzyme-linked immunosorbent assay (ELISA). Treatment with ciprofloxacin was initiated, leading to the resolution of fever but subsequent lymph node suppuration. Prompt drainage and a course of doxycycline resulted in patient healing and discharge. This case underscores the importance of considering tularemia in patients presenting with tonsillitis, fever, and lymphadenitis, particularly in endemic and rural areas, and emphasizes the necessity of timely diagnosis and early treatment to prevent complications and economic burdens.