Tularemia Takes a Tropical Turn: A Rare Case of Typhoidal Tularemia in Florida.

BACKGROUND Florida is not a common area for tularemia infection; in fact, only 4 cases have been reported over the past 10 years. Here, we present the case of a 36-year-old man with no significant past medical history and no recent travel who presented with 6 months of vague symptoms including fatigue, night sweats, and unintentional weight loss who was found to have tularemia. CASE REPORT A 36-year-old man with no significant past medical history presented to his primary care physician with a 6-month course of fevers, malaise, rigors, night sweats, and a 30-pound unintentional weight loss. On questioning, the patient was discovered to hunt deer and wild turkey, which prompted testing for tularemia. Francisella tularensis IgM testing was positive, confirming the diagnosis of tularemia suspected to have been borne by a tick vector. Our patient was started on levofloxacin 750 mg daily for 14 days. His febrile episodes resolved within 7 days of initiating antibiotics. CONCLUSIONS In this patient's case, tularemia was not considered initially in his evaluation as cases are rare in Florida, and his typhoidal presentation had such a broad differential of infectious, rheumatologic and malignant processes. With climate patterns changing, to which insect vectors are particularly sensitive, re-emergence of otherwise rare infectious disease pathogens can be seen and should be explored in otherwise difficult-to-diagnose cases.