Not Tuberculosis After All: The "Hare-Raising Case" of Tularemia in a Patient With Advanced HIV Infection

We report a rare case of pneumonic tularemia in a person with an advanced HIV infection, in which a mediastinoscopy was ultimately required for microbiological confirmation. Serological testing remained negative. This case illustrates the extent to which pneumonic tularemia can mimic pulmonary tuberculosis and illustrates the limitations of serology in immunocompromised individuals. Clinicians should consider tularemia in the differential diagnosis of pulmonary disease with necrotizing lymphadenopathy, even in regions where the incidence is low.