# Behind the COVID-19 Curtain: A Rare Case of Autochthonous Pneumonic Tularemia in Portugal

## TL;DR

A 63-year-old woman in Portugal was diagnosed with pneumonic tularemia, a rare disease caused by Francisella tularensis, during a SARS-CoV-2 infection.

## Contribution

This is the first reported case of autochthonous pneumonic tularemia in Portugal.

## Key findings

- A 63-year-old woman presented with pneumonia and SARS-CoV-2 infection.
- Serology confirmed Francisella tularensis infection, and the patient improved with targeted treatment.

## Abstract

The presence of Francisella tularensis has been well documented in Portugal; however, reports of human infection remain rare. We report the case of a 63-year-old woman presenting with pneumonia and SARS-CoV-2 infection. The relapsing course of infection, partial response to fluoroquinolone and macrolide antibiotics, and epidemiological background led to the suspicion of an underlying zoonotic disease. Serology later confirmed F. tularensis infection, and the patient improved under directed therapy. To the best of our knowledge, this is the first case of autochthonous pneumonic tularemia reported in Portugal.