Tijdschrift voor geneeskunde vol:60 issue:22 pages:1613-1618
Persistent fever and asthenia in a 42-year-old garagist
We report a case of a male patient presenting with persistent fever, asthenia, non-purulent cough and loss of weight. Clinical examination and radiology did not reveal abnormalities. Serum analysis revealed pancytopenia, raised CRP, sedimentation rate and liver enzymes. A PET-scan was normal. Bone marrow biopsy showed the presence of granulomas.
Extensive testing of the serology proved positive for Coxiella burnetii. Q fever is an ubiquitous zoonosis with a large reservoir. The disease may be acquired by the respiratory or digestive route after contact with parturient sheep or cattle. Going over the medical history again - after diagnosis - revealed that this patient indeed had been in contact with parturient sheep.
The incidence of Q fever is unknown and may be underestimated. The clinical presentation of Q fever is polymorphic and nonspecific; it may be acute, most often as a pneumonia or hepatitis, or chronic, most often as an endocarditis. Inapparent and subclinical infections are common. The diagnosis of Q fever relies mainly upon serology, the most commonly used method being the immunofluorescence assay. Serological testing for Q fever should always be done for a patient with prolonged fever, granulomatous lesions in the liver or bone marrow, and culture-negative endocarditis.
This case illustrates the importance of a meticulous history taking, and the usefulness of a bone marrow biopsy in patients with prolonged fever. Our patient was successfully treated with tetracyclines.