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2017 OMIG Abstract 9

Oculoglandular Tularemia: Case Report with Microbiologic Correlation and Safety Implications
Kenneth J. Taubenslag, MD; Lea Ann A. Lope, DO; Marian G. Michaels, MD, MPH;
Matthew S. Pihlblad, MD;  Christin L. Sylester, DO; Regis P. Kowalski, MS, M(ASCP)
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania


Purpose: To report a case of oculoglandular tularemia with an emphasis on microbiologic findings and safety protocols. 

Methods: A previously healthy twelve-year-old was transferred for fever, headache, and unilateral red eye due to concern for orbital cellulitis. Ophthalmic exam revealed unilateral hemorrhagic conjunctivitis without orbital signs. Computed tomography showed mild preseptal edema, and the patient was discharged with a tentative diagnosis of viral conjunctivitis. He returned three days later with high-grade fevers, massive submandibular lymphadenopathy, and a granulomatous conjunctivitis with chemosis. Further history revealed multiple animal exposures.

Results: Laboratory work-up demonstrated elevated inflammatory markers and neutrophilic leukocytosis. Bartonella hensellae and B. quintana serologies were negative and tularemia serology was equivocal (1:80). Conjunctival culture grew Gram negative coccobacilli, resembling Haemophilus except for negative satellite testing. Molecular sequencing identified Francisella tularensis, and the patient was successfully treated with oral and topical ciprofloxacin, chosen due to susceptibility estimates obtained prior to identification. As tularemia is not endemic to western Pennsylvania, the ophthalmic laboratory was not alerted to the possibility of the diagnosis. Consequently, multiple laboratory personnel with exposure went on fever watch and/or prophylactic doxycycline. 

Conclusion: Francisella tularensis is an extremely rare cause of the oculoglandular syndrome. This is the first case of oculoglandular tularemia in western Pennsylvania in the literature suggesting the possibility of a shifting geographic distribution. The case furnishes previously unreported estimation of susceptibilities to ophthalmic topical antibiotics and highlights the need to consider the diagnosis even outside endemic areas due to the precautions requisite to protect laboratory personnel.

Disclosure: N



2017 Agenda and Abstracts | < Previous Next >