25 year-old presents to the with right eye pain and redness for two days duration. One week ago he returned from a summer hunting trip in Oklahoma, where he was bitten by many mosquitos and removed 3 embedded ticks. During his trip, he hunted and dined on squirrel, rabbit and deer meat, which he butchered and prepared with his bare hands. He denies any animal bites, scratches, or known exposure to urine.
Initially his eyes were irritated and then progressed to photophobia and eye pain. ROS includes subjective fevers and chills. Denies diarrhea, rash, abdominal pain, muscle cramping, nausea or vomiting.
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Correct Answer: Francisella tularensis
This case describes ocular-glandular syndrome from tularemia caused by direct entry into eye following contact with infected bodily fluids.
- Patients typically have unilateral eye pain, photophobia, and potentially purulence as demonstrated in the picture within this case
- His recent hunting trip including butchering rabbits and squirrels which was likely the source of entry into conjunctiva
- A unique presentation that is often tested is Parinaud’s oculoglandular syndrome: unilateral conjunctivitis and pre-auricular lymphadenopathy on same side. Other common infectious causes of Parinaud’s syndrome include Bartonella and Herpes Simplex Virus.
Distractor answer choices
Streptobacillus moniliformis: Rat Bite Fever
- Associated with rat bites/scratches, typically presents with fever, nausea/vomiting and rash
Salmonella spp: Salmonellosis
- Commonly carried by reptiles and birds, typically presents with fever and vomiting/abdominal cramps
Yersinia pestis: Plague (bubonic or pneumonic)
- Transmitted via bites from rat-dwelling fleas, typically presents with painful lymphadenopathy
Leptospira spp: Leptospirosis
- Transmitted by contact with rodent urine, typically presents with conjunctival suffusion= eye redness and chemosis without conjunctival drainage
Written by Jeremey Walker at UAB, edited by Martin Rodriguez
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This question was uploaded on 3/29/22