Francisella philomiragia: Think of Chronic Granulomatous Disease

Excerpt

A 20-year-old man was referred to our department with fever (about 38 °C), odynophagia, and dry cough for 2 weeks. He has a history of chronic granulomatous disease (CGD) linked X, diagnosed 18 months of birth, and he received primary prophylaxis with trimethoprim-sulfamethoxazole and itraconazole since. He had maternal uncle affection, being his mother the carrier of the mutation. He denied sore throat, neck pain, hoarseness, stridor, dyspnea, chest pain, arthralgia, or weight loss. He returned from recently holidays in Mediterranean beach. The examination revealed hyperemic pharynx, mild tonsillar hypertrophy, submandibular lymph nodes of 2 cm diameter and 1 cm at neck, mobile and not painful. Respiratory and systemic examination was normal. In the chest radiograph, a pulmonary nodule 2 cm in the right lower lobe was evident. Amoxicillin and clarithromycin were prescribed, but the fever and cough were not solved. A CT scan showed a nodular diffuse bilateral pattern more prevalent in the lower lobes with hiliar lymphadenopathy (Fig. 1). Abdominal ultrasound and echocardiography showed no relevant findings. On two blood cultures was isolated Francisella philomiragia. Genus and species identification was confirmed via 16S ribosomal RNA sequence analysis. The isolate showed susceptibility to cefotaxime, carbapenem, tetracycline, quinolon, chloramphenicol, and rifampin. The patient was treated with levofloxacin, resolving the infectious process.

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