An Overlooked Cause of Cervical Lymphadenopathy: Tularemia

Aim: Tularemia, a re-emerging zoonosis caused by Francisella tularensis, often presents as cervical lymphadenopathy in its oropharyngeal form, mimicking common infections. This clinical overlap leads to significant diagnostic delays and complications. We aimed to evaluate diagnostic delays, antibiotic use patterns, and clinical outcomes in patients with oropharyngeal tularemia presenting with cervical lymphadenopathy.Materials and Methods: We retrospectively reviewed 22 patients admitted to our center in Konya, Türkiye, with cervical lymphadenopathy between January 2005 and January 2025. Diagnosis was confirmed by Microagglutination Test (MAT) titers ≥1/160. To ensure a homogenous cohort, patients with other clinical forms, equivocal serology, or alternative etiologies (e.g., tuberculosis, malignancy) were excluded. Statistical analyses were performed using IBM SPSS 26.0. Mann-Whitney U and Fisher’s exact tests were used to identify potential predictors of local complications. Ethical approval for the study was granted by the Necmettin Erbakan University Faculty of Medicine, Non-Drug and Medical Device Research Ethics Committee (Decision No: 2025/6243, Date: December 26, 2025).Results: The mean age was 43.7 ± 16.4 years, with a female predominance (77.3%). Drinking untreated tap water was identified as a probable epidemiological risk factor in 72.7% of cases. The median diagnosticdelay was notably prolonged at 60 days (30–90), and among the 20 patients with available data, 75% (n=15) had received antibiotics before diagnosis. Local complications (suppuration/abscess) requiring surgical drainage occurred in 40.9% of patients. Statistical analysis revealed no significant correlation between clinical/laboratory parameters and the development of complications (p > 0.05). The most frequent treatment was doxycycline combined with streptomycin (40%).Conclusions: Tularemia should be the primary differential diagnosis for long-standing, treatment-resistant cervical lymphadenopathy in endemic areas. Prolonged diagnostic delays and inappropriate beta-lactam use were common in this cohort and may contribute to preventable morbidity.