Ulceroglandular Tularemia in a Pediatric Patient in Maine After a Trip to Martha’s Vineyard

Introduction: Vector-borne lymphadenitis in children is uncommon. A detailed exposure and travel history can facilitate diagnosis. Clinical Findings: The pediatric inpatient service admitted a 6-year-old patient after multiple acute care visits for right posterior auricular tenderness, erythema, and swelling. Clinical Course: Upon admission, the patient received intravenous ceftriaxone and clindamycin for progressive suppurative lymphadenitis. After a review of the patient’s history, which included the removal of an engorged tick and recent travel to Martha’s Vineyard, Massachusetts, the treatment was transitioned to intravenous gentamicin for ulceroglandular tularemia. Conclusions: Francisella tularensis can be transmitted via tick and deer-fly bites and should be considered in patients with an exposure history and compatible symptoms, such as skin ulceration, and lymphadenopathy after traveling to endemic regions.