Which disease presents with an erythematous plaque at the tick bite site and painful regional lymphadenopathy (ulceroglandular form)?

Which disease presents with an erythematous plaque at the tick bite site and painful regional lymphadenopathy (ulceroglandular form)?

• A. Lyme disease
• B. Ehrlichiosis
• C. Tularemia
• D. Colorado Tick Fever

Answer: (C)

Ulceroglandular tularemia is the diagnosis suggested by an ulcer at the tick bite site with painful regional lymphadenopathy. It results from infection with Francisella tularensis transmitted by ticks or contact with infected animals. The typical lesion starts as a small papule that evolves into an erythematous ulcer (often with surrounding redness), and nearby regional lymph nodes swell and are tender as the infection drains to them. This combination—an inoculation-site ulcer and painful, regional lymphadenopathy—is classic for tularemia. Lyme disease, by contrast, classically presents with erythema migrans, an expanding bull’s-eye rash, but not an ulcerated lesion with tender regional lymph nodes. Ehrlichiosis usually presents with fever, malaise, and cytopenias, with rash in some cases but without a primary ulcer at the bite site and characteristic ulceroglandular lymphadenopathy. Colorado tick fever features fever and myalgias and is not marked by a localized ulcer and tender regional lymphadenopathy.

Ulceroglandular tularemia is the diagnosis suggested by an ulcer at the tick bite site with painful regional lymphadenopathy. It results from infection with Francisella tularensis transmitted by ticks or contact with infected animals. The typical lesion starts as a small papule that evolves into an erythematous ulcer (often with surrounding redness), and nearby regional lymph nodes swell and are tender as the infection drains to them. This combination—an inoculation-site ulcer and painful, regional lymphadenopathy—is classic for tularemia.

Lyme disease, by contrast, classically presents with erythema migrans, an expanding bull’s-eye rash, but not an ulcerated lesion with tender regional lymph nodes. Ehrlichiosis usually presents with fever, malaise, and cytopenias, with rash in some cases but without a primary ulcer at the bite site and characteristic ulceroglandular lymphadenopathy. Colorado tick fever features fever and myalgias and is not marked by a localized ulcer and tender regional lymphadenopathy.