Abstract

Fever is one the most common paediatric presentations at the emergency department, but it is difficult to identify its cause because it is an unspecific symptom. In most cases, fever is due to self-limited viral infections. Prolonged fever is a diagnostic challenge for doctors because it may be difficult to distinguish between benign and potentially lifethreatening causes. When fever lasts longer than at least eight days, and the source is unclear it is considered fever of an unknown origin (FUO). There are many causes of FUO and one of them might be tularemia, which had previously diagnosed only once in the Estonian paediatric population.
We present a case of a 15-year-old boy who was hospitalised at Tallinn Children’s Hospital after 10 days of fever, malaise, and joint pain. On the left arm there was a skin ulcer at a recent tick bite site accompanied by regional abscess-forming lymphadenopathy. Antibiotic therapy with beta-lactam antibiotics had no effect. On the suspicion of ulceroglandular tularemia, the antibiotic was changed to ciprofloxacin and clinical improvement was achieved. Serologic analysis confirmed diagnosis of tularemia.