CASE REPORT
Skin ulcer and maculopapular rash with inguinal lymph node enlargement: a case report of a 46-year-old female patient from north-eastern Poland with Rickettsia spp. and Francisella tularensis co-infection
1
Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Poland
2
Students’ Scientific Association, Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Poland
3
National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
Submission date: 2024-12-09
Final revision date: 2025-04-03
Acceptance date: 2025-04-07
Online publication date: 2025-09-22
Publication date: 2025-09-22
Cent Eur J Immunol 2025;(3):314-318
KEYWORDS
ABSTRACT
North-eastern Poland is an endemic region for tick-borne diseases, especially Lyme disease and tick-borne encephalitis. However, less common diseases such as rickettsiosis and tularemia may occur after a tick bite.
In this paper we present a rare case of Rickettsia spp. and Francisella tularensis co-infection in a 46-year-old female patient with no history of travel and no chronic diseases, confirmed by serological and molecular tests. The symptoms appeared 5-7 days after the tick bite and lasted for 2 weeks. On physical examination, a maculopapular rash over the entire body, an ulcer on the left lower extremity, and an enlarged inguinal lymph node were noted.
We concluded that rare diseases such as rickettsiosis and tularemia should be included in differential diagnosis of fever, lymphadenopathy and skin changes after a tick bite. Co-infection with Rickettsia spp. and F. tularensis is possible in patients after a tick bite. Quick diagnosis allows proper treatment (with doxycycline) and complete recovery.
In this paper we present a rare case of Rickettsia spp. and Francisella tularensis co-infection in a 46-year-old female patient with no history of travel and no chronic diseases, confirmed by serological and molecular tests. The symptoms appeared 5-7 days after the tick bite and lasted for 2 weeks. On physical examination, a maculopapular rash over the entire body, an ulcer on the left lower extremity, and an enlarged inguinal lymph node were noted.
We concluded that rare diseases such as rickettsiosis and tularemia should be included in differential diagnosis of fever, lymphadenopathy and skin changes after a tick bite. Co-infection with Rickettsia spp. and F. tularensis is possible in patients after a tick bite. Quick diagnosis allows proper treatment (with doxycycline) and complete recovery.
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| eISSN: | 1644-4124 |
| ISSN: | 1426-3912 |
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