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Arch Dermatol. 2004;140:1531-1536.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Diagnosis: Tularemia.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

The skin biopsy specimen demonstrated necrotic foci within the dermis, neutrophils, leukocytoclastic debris, and an area surrounded by a granulomatous inflammatory infiltrate. High magnification demonstrated an infiltrate of histiocytes and giant cells adjacent to an area of necrosis. Special stains (methenamine silver, tissue gram stain, and acid-fast bacilli) were negative for organisms. Tissue cultures and aspirates from a fluctuant lymph node were negative for bacteria and fungi. Titers for plague, Coccidioides, and tularemia were measured, and a Francisella tularensis titer of 1:320 was obtained (negative, <1:80).

The patient was treated empirically with levofloxacin pending the results of the serologic tests and cultures and showed some initial improvement. The levofloxacin therapy was changed to intramuscular streptomycin therapy after the positive tularemia titer was obtained. The patient had a complete recovery with a 2-week course of streptomycin therapy.

DISCUSSION

Tularemia, a zoonotic disease caused by the gram-negative bacterium F tularensis, was . . . [Full Text of this Article]

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Arch Dermatol. 2004;140(12):1531-1536.
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