A 44-year-old female was admitted because of tender, enlarged inguinal lymph nodes with a history of tick bite five weeks earlier. In the place of a tick bite on the skin a small ulcer was present. The primary symptoms before admission suggested typical diseases related to tick bite such as
Lyme borreliosis and tick-borne encephalitis, what corresponded with positive IgM ELISA test for
Lyme borreliosis. The course of
disease however clarified the diagnosis of tularaemia, which is a relatively rare
disease in Poland (6 cases per 40 million population are reported annually). The ultimate diagnosis was confirmed by serological tests.