Ulceroglandular Tularemia with Systemic Features Following Direct Wild Animal Contact

Abstract: Tularemia is an uncommon but potentially severe zoonotic infection caused by Francisella tularensis, with diverse clinical manifestations that may complicate timely diagnosis. We describe the case of a 79-year-old woman who developed progressive ulcerative hand lesions and systemic symptoms following direct contact with a wild badger while attempting to protect her dog. Her clinical course was marked by delayed recognition, polymicrobial wound cultures, hyponatremia, and profound fatigue, ultimately leading to the diagnosis of ulceroglandular tularemia with systemic features. Diagnosis was confirmed by operative culture and markedly elevated F. tularensis serologic titers. She responded favorably to aminoglycoside-based therapy followed by prolonged doxycycline, with complete resolution of symptoms. This case highlights the importance of detailed exposure history, recognition of atypical presentations, and early consideration of tularemia in patients with nonhealing soft tissue infections and systemic symptoms in endemic regions.