Central Nervous System Vasculitis Due To An Endemic Zoonosis In Turkey; Tularemia

Tularemia is a bacterial zoonotic disease. The etiologic agent is francisella tularensis which is a gram negative coccobacillus. It is also an epidemic disease in some parts of Turkey. Clinical forms are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory, and typhoidal forms. Neurological involvement is rare. It is usually presented with meningitis and encephalitis in literature.Our 42-year-old patient was suspected for demyelinating disease, ischemic cerebrovascular disease and vasculitis because of acute onset of neurological symptoms. She was diagnosed as tularemia during the investigation of her lymphadenitis. No etiologic risk factor was found for cerebrovascular disease, and demyelinating disease was excluded. Digital substraction angiography revealed the narrowing of the cerebral vessels. The lesions were partially regressed with the treatment. However, a new infarction developed with the interruption of treatment. All these findings suggested the diagnosis of central nervous system vasculitis due to francisella tularensis infection.Our case was important as it was the first vasculitic case due to tularemia in the literature.