Tissot N, Noureddine S, Guion-Dusserre M, Soumagne T
Service de maladies infectieuses, centre hospitalier universitaire de Nancy, Vandœuvre-lès Nancy, France.
Service de pneumologie, centre hospitalier universitaire Jean Minjoz, Besançon, France.
Rev Mal Respir. 2021 Feb;38(2):204-209. doi: 10.1016/j.rmr.2020.11.013. Epub 2021 Feb 10.
Mediastinal lymphadenopathy is a common cause of referral to the pulmonologist. In addition to more frequent aetiologies such as malignancy, sarcoidosis, tuberculosis and lymphoma, unusual causes must be considered, especially in specific contexts.
We report the cases of three young patients referred to our pulmonology department for the assessment of hypermetabolic mediastinal lymphadenopathy. The context of the onset of symptoms (tick bite, contact with an infected animal) as well as paraclinical investigations (Francisella tularensis serology) made it possible to make a diagnosis of tularemia. The clinical and radiological evolution was favourable in all three cases. Tularemia is a rare but currently re-emerging infection caused by a Gram negative coccobacillus, Francisella tularensis. Human contamination occurs mainly through contact with infected animals or by tick bites. The diagnosis can be difficult because the symptoms (fever, diffuse myalgia) are non-specific, and is based on serology and an appropriate clinical context. Treatment is based on ciprofloxacin or doxycycline.
The diagnosis of tularemia must be considered in the presence of lymphadenopathy occurring after a tick bite or contact with an infected animal.
纵隔淋巴结肿大是呼吸科医生会诊的常见原因。除了更常见的病因，如恶性肿瘤、结节病、结核病和淋巴瘤外，还必须考虑不寻常的病因，尤其是在特定情况下。
我们报告了三名年轻患者转诊至我们呼吸科评估高代谢性纵隔淋巴结肿大的病例。症状发作的背景（蜱叮咬、接触受感染动物）以及辅助检查（土拉弗朗西斯菌血清学）使得诊断出兔热病成为可能。所有三例患者的临床和影像学演变均良好。兔热病是一种由革兰氏阴性球杆菌土拉弗朗西斯菌引起的罕见但目前正在重新出现的感染。人类感染主要通过接触受感染动物或蜱叮咬发生。诊断可能困难，因为症状（发热、弥漫性肌痛）是非特异性的，并且基于血清学和适当的临床背景。治疗基于环丙沙星或多西环素。
在蜱叮咬或接触受感染动物后出现淋巴结肿大时，必须考虑兔热病的诊断。
