Case history
Case history #1
A 52-year-old man is admitted to the emergency department with fever. He has had malaise and headache for 30 days. The patient has been working in an abattoir for several years. Laboratory workup shows an elevated white blood cell count. Transthoracic echocardiography shows aortic valve vegetations. Blood cultures are repeatedly negative for a causative organism. A lack of improvement while on intravenous antibiotics prompts surgical intervention and valve replacement. Following surgery, serologies for Coxiella burnetii are positive. Diagnosis is confirmed by polymerase chain reaction (PCR) of excised heart valve tissue.
Case history #2
A 65-year-old retired man with no particular history and living in an endemic area for C burnetii presents with febrile acute hepatitis that resolves spontaneously without treatment. Transthoracic echocardiography is normal. At the 3-month follow-up consultation, he is asymptomatic, but his C-reactive protein is 50 mg/L (476 nanomol/L). A C burnetii serology is performed. Phase I titers for immunoglobulin G (IgG), IgM, and IgA are 1:51,200, 0, and 1:3200, respectively. Phase II titers for IgG, IgM, and IgA are 1:102,400, 0, and 1:6400, respectively. PCR of blood is negative for C burnetii. Positron emission tomography/computed tomography (PET/CT) scan shows a fixation of the aortic valve, and a double thoracic and lumbar aortic aneurysm.
Other presentations
A 21-year-old male soldier presents to the emergency department 7 days after returning from Iraq, with severe headache, malaise, cough, and high fever. Laboratory studies show elevated white blood cell count and elevated transaminases. Hepatitis B and C serologies are negative; an HIV test is also negative. A chest x-ray shows nodular opacities.
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