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February 13, 2007; 68 (7) NeuroImages

Tularemia with brain abscesses

D. van de Beek, J. M. Steckelberg, W. F. Marshall, S. Kijpittayarit, E.F.M. Wijdicks
First published February 12, 2007, DOI: https://doi.org/10.1212/01.wnl.0000250246.01304.98
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After eating wild rabbits, a 51-year-old woman presented with fever, headache, blurry vision, and declined consciousness. Uveitis and pulmonary infiltrates were present, CSF examination revealed leukocytes of 450/mm3, and cultures grew Francisella tularensis. Streptomycin and doxycycline were started. CT was normal, but cranial MRI showed three lesions with restricted diffusion (figure). Outcome at one year was poor.

Figure1

Figure. Fluid-attenuated inversion recovery weighted MRI (axial view [A and C]) showing meningeal enhancement, enlarged ventricles, and hyperintense lesions in right temporal lobe and right posterior occipital lobe; T1-weighted images (B and D) after gadolinium showed ring-enhancing lesions.

The diagnosis of tularemia rests on specific inquiry into exposure with the bacillus, use of specific culture media, and serologic testing.1 Due to its extreme virulence and ease of aerosol dissemination, there has been renewed interest in tularemia as a potential bioweapon.2

1. Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev 2002;15:631–646.OpenUrlAbstract/FREE Full Text

2. Oyston PC, Sjostedt A, Titball RW. Tularaemia: bioterrorism defence renews interest in Francisella tularensis. Nat Rev Microbiol 2004;2:967–278.

Footnotes

  • Dr. van de Beek received research grants from the Meerwaldt Foundation and is supported by a personal grant of the Netherlands Organization for Health Research and Development (ZonMw); NWO-Rubicon grant 2006 (019.2006.1.310.001).

    Disclosure: The authors report no conflicts of interest.

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