Rare pulmonary tularemia masquerading as lung cancer: importance of considering infectious etiologies and a comprehensive literature review.

Cases of tularemia in humans are rare in the Czech Republic, and pulmonary involvement is exceptional; consequently, it is seldom considered in the initial differential diagnosis. We report the case of a patient admitted with complicated pneumonia. Radiological imaging revealed a centrally located mass in the right lung with surrounding extensive pneumonia and regional lymphadenopathy, raising suspicion of lung carcinoma or pneumonia complicated by abscess formation. The patient subsequently underwent lobectomy. Histopathological examination demonstrated a necrotizing granulomatous process, and molecular analysis confirmed infection with Francisella tularensis. Pulmonary tularemia was therefore diagnosed only after surgical resection. Review of the literature reveals that pulmonary tularemia may closely mimic lung cancer or lymphoma on clinical and radiological grounds, frequently resulting in delayed diagnosis. Increased awareness of this rare entity among clinicians and pathologists may facilitate earlier recognition and prevent unnecessary extensive surgical interventions.