Our patient's symptoms were fever, pharyngitis, and cervical lymphadenopathy; treatment with a p-lactam drug did not improve her condition, which rapidly evolved to local suppuration
, a sign that should prompt physicians to consider oropharyngeal tularemia in disease-endemic regions.
5,10) If the cyst is infected, it is advisable to install an irrigation-drainage system to prevent secondary collections and suppurations of the residual cavity and detect for urinary fistula.
No urinary fistula or suppuration of the residual cavity was noted.
During the examination, location and number of lesions were noted, and the following signs and symptoms were observed: erythema, edema, tenderness, itching, pain, shining skin, desquamation, hyperkeratosis, fissures, pustules, suppuration, ulcers, deformation of the toes (defined as deviation of the normal axis of the toe caused by intense swelling), deformation of nails, loss of nails, and difficulty in walking or gripping.
Clinical pathologic findings were classified as follows: acute inflammation or painful lesion surrounded by erythema, edema, and tenderness; chronic inflammation, edema, tenderness, shining skin with or without desquamation, or deformation of digits; superinfection, presence of pustules, suppuration, or ulcers; and physical disability, difficulty in walking, or gripping (if lesions were located on the hands), based on patients' statements that pain restricted their movements.