Acute Q fever presenting as fever of unknown origin with rapidly progressive hepatic failure in a patient with alcoholism

Po Han Lin, Yi Chun Lo, Fu Tien Chiang, Jiun Ling Wang, Yung MIng Jeng, Chi Tai Fang, Shan Chwen Chang

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)896-901
Number of pages6
JournalJournal of the Formosan Medical Association
Volume107
Issue number11
DOIs
Publication statusPublished - 2008 Nov

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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