Capellan and Fong (Clin Infect Dis 16:472–475, 1993) described a 63-year-old man who developed ulceroglandular tularemia complicated by pneumonia after a cat bite. He initially presented with pain and...

Capellan and Fong (Clin Infect Dis 16:472–475, 1993) described a 63-year-old man who developed ulceroglandular tularemia complicated by pneumonia after a cat bite. He initially presented with pain and localized swelling of his thumb 5 days after the bite. Oral penicillins were prescribed, but the patient’s condition worsened, with increased local pain, swelling, and erythema at the wound site, and systemic signs (fever, malaise, vomiting). Incision of the wound was performed, but no abscess was found; culture of the wound was positive for a light growth of coagulase-negative staphylococci. Intravenous penicillins were prescribed, but the patient continued to deteriorate, with the development of tender axillary lymphadenopathy and pulmonary symptoms. A chest radiograph revealed pneumonic infiltrates in the right middle and lower lobes of the lung. The patient’s therapy was changed to clindamycin and gentamicin, which was followed by defervescence and improvement of his clinical status. After 3 days of incubation, tiny colonies of faintly staining gram-negative coccobacilli were observed on the original wound culture. The organism was referred to a national reference laboratory, in which it was identified as Francisella tularensis. A more complete history revealed that the patient’s cat lived outdoors and fed on wild rodents. This case illustrates the difficulty in making the diagnosis of tularemia and the lack of responsiveness to penicillins.