Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.

Chronic urticaria: an unusual initial manifestation of primary hyperparathyroidism.

OBJECTIVE: To discuss the rare association between primary hyperparathyroidism and chronic urticaria. METHODS: A case report with clinical and laboratory details is presented, and the pertinent literature is reviewed. RESULTS: A 29-year-old patient with chronic urticaria for more than 2 years, which was partially responsive to medical treatment, was found to have primary hyperparathyroidism. After parathyroidectomy, the urticaria resolved, and it has not recurred during a 1-year follow-up period. CONCLUSION: Primary hyperparathyroidism can be a rare cause of chronic urticaria.