Tularemia-associated septic shock with pneumonia, lung abscesses, and pleural effusion leading to multiorgan failure: Is Francisella tularensis still a deadly pathogen in the antibiotic era? A case report.

OBJECTIVES: Francisella tularensis is a Gram-negative coccobacillus causing tularemia. Due to its high infectivity and potential for aerosol transmission, it is considered a potential biological weapon. Although tularemia is rare in most regions, it can cause severe community-acquired infections, particularly in individuals with environmental exposure, and may be life-threatening.

PATIENTS AND METHODS: We report a confirmed case of F. tularensis infection diagnosed despite diagnostic difficulties. The patient developed pulmonary tularemia complicated by sepsis and lung abscess formation. The hospital course was further complicated by secondary infections with multidrug-resistant pathogens. Treatment was initiated according to current recommendations and resulted in initial clinical improvement.

RESULTS: The patient was discharged but died shortly afterward. It remains unclear whether death was directly related to tularemia or to other complications and comorbidities.

CONCLUSIONS: This case highlights the importance of careful exposure history in patients with atypical or treatment-refractory pneumonia, which may indicate uncommon etiologic agents.