Acute Q fever presenting as fever of unknown origin with rapidly progressive hepatic failure in a patient with alcoholism
Journal
Journal of the Formosan Medical Association
Journal Volume
107
Journal Issue
11
Pages
896
Date Issued
2008-01-01
Author(s)
Abstract
We report a case of fulminant acute Q fever presenting as fever of unknown origin with rapidly progressive hepatic failure in a patient with alcoholism. A 51-year-old electrician, who was a habitual drinker, presented with a 2-week history of intermittent high fever, acute hepatomegaly and rapidly progressive jaundice after being accidentally exposed to dust from bird nests when he was repairing electrical equipment and circuitry at an abandoned factory in Taipei County. Ascites and prolonged prothrombin time were noted at admission. Transjugular liver biopsy and bone marrow biopsy found multiple small fibrinoid-ring granulomas in liver parenchyma and bone marrow. Doxycycline therapy was empirically started. The fever gradually subsided over a 2-week period, along with the recovery of liver function. The diagnosis of acute Q fever was confirmed by high titers of antibodies against Coxiella burnetii (phase I IgM 1: 160 and IgG 1:2560, phase II IgM > 1:320 and IgG 1:5120) and a four-fold elevation of phase II IgG titer in the paired serum. The experience of this case shows that the possibility of Q fever should not be overlooked in patients who have an unexplained febrile illness and severe liver function impairment following exposure to a contaminated environment in Taiwan. © 2008 Elsevier & Formosan Medical Association.
Subjects
Doxycycline | Hepatitis | Liver failyre | Q fever
SDGs
Other Subjects
alanine aminotransferase; aspartate aminotransferase; bilirubin; ceftriaxone; doxycycline; hydroxychloroquine; immunoglobulin G; abnormal respiratory sound; adult; alanine aminotransferase blood level; alcoholism; anamnesis; article; aspartate aminotransferase blood level; bilirubin blood level; blood culture; bone marrow biopsy; case report; clinical feature; differential diagnosis; disease severity; echography; environmental exposure; fever; hepatomegaly; histopathology; human; human tissue; jaundice; leukocyte count; liver biopsy; liver failure; male; physical examination; prothrombin time; pyrexia idiopathica; Q fever; thorax radiography; treatment response
Type
journal article