Tularemia Hand Infection From a Cat Bite—A Case Report

Tularemia is an uncommon infection caused by the bacterium Francisella tularensis. The nonspecific presentation and infrequency with which it is encountered make it a diagnostic challenge. A rare and scarcely reported mode of tularemia inoculation is a cat bite to the hand. We report a cat bite hand infection with tularemia in a 66-year-old woman. She underwent treatment for presumed polymicrobial cellulitis. Over the next 5 days, the symptoms progressed to fever, malaise, and fluctuant lymphadenitis with nodules along draining lymphatics. Cultures grew F tularensis and antibiotics were switched to doxycycline, which resolved the infection. The patient remained symptom-free after the doxycycline was discontinued. The purpose of this case study is to alert treating providers to consider tularemia infection when a hand infection persists, particularly in the context of an animal bite.