Clinicopathologic features of q Fever patients with acute hepatitis

Abstract

Background: Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described.

Methods: Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests.

Results: All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure.

Conclusions: C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.

Keywords: Coxiella burnetii; Granuloma; Hepatitis; Liver biopsy; Q fever.

Fig. 1

Granuloma types in liver biopsies from patients with acute Q fever hepatitis. (A) Typical fibrin ring granuloma consists of central lipid cores surrounded by a fibrin ring with mixed cellular infiltration. (B) Epithelioid granuloma with numerous eosinophils and multiple giant cells. (C) Extensive extravasated fibrin without ring configuration mimicking necrotizing granuloma. (D) Acute cholangitis without granulomas. (E) Typical fibrin ring granuloma (Masson's-trichrome stain). (F) Extravasated fibrin without ring configuration (Masson's-trichrome stain). ^*Inset of (A), fibrin ring granuloma from a bone marrow biopsy.