Ulceroglandular tularemia.

A 14-year-old boy presented with fevers and nonspecific flu-like symptoms, as well as an enlarging ulcerated plaque involving the upper back, lymphadenopathy, and bilateral pulmonary nodules. Bacterial cultures of ulcer tissue grew Francisella tularensis on enriched chocolate agar plates. Making the diagnosis requires a high index of suspicion, and communication with the laboratory to successfully and safely culture these highly pathogenic bacteria is imperative.