Tularemia presenting as a unilateral pleural effusion in a metropolitan city

We report a young patient who went on a camping trip to a local park in a metropolitan area complaining of chest pain. On further investigations, he was found to have left sided pleural effusion. Thoracentesis revealed alkaline PH and the fluid was an exudate. The culture grew Francisella tularensis. The patient was treated with streptomycin with marked clinical improvement.