Skin manifestations of tularemia: a study of 88 cases in northern Finland during 16 years (1967-1983)

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Abstract
88 tularemia patients with secondary skin manifestations seen in northern Finland during 1967-1983 are described in this paper. Tularemia was ulceroglandular in 57% and pulmonary in 27% of the patients. 68% of the patients were women. The most common secondary skin manifestation was papular or vesicopapular eruption which was seen in 42% of the patients. Erythema nodosum either alone or in combination with some other skin eruption was encountered in 28% and erythema multiforme in 9% of the patients. Erythema nodosum was seen more often in patients with pulmonary tularemia than in other types of the disease (p less than 0.01). The clinical pictures of erythema nodosum and erythema multiforme caused by tularemia greatly resembled those caused by Yersinia. Tularemia should be remembered as one possible triggering factor of erythema nodosum and erythema multiforme.