Lymphadenopathy is a common symptom in children, yet sometimes it may represent a differential diagnostic pitfall. Tularemia is one of the rare causes of lymphadenopathy in childhood.
A clinical suspicion should arise in cases with history of insect bite or animal contact, granulomatous inflammation in biopsy specimen, negative culture results, and/or in cases which fail to respond to first-line antibiotics. Hereby, three cases of children with unexplained lymphadenopathy are presented, highlighting the practical aspects and issues potentially associated with the diagnosis and management of tularemia.