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Review
. 2014 Feb 5:2014:bcr2013202843.
doi: 10.1136/bcr-2013-202843.

Two rare manifestations of Q fever: splenic and hepatic abscesses and cerebral venous thrombosis, with literature review ma non troppo

Manuel Mendes Gomes  1 , Andreia Chaves, Ana Gouveia, Lèlita Santos
Affiliations
Review

Two rare manifestations of Q fever: splenic and hepatic abscesses and cerebral venous thrombosis, with literature review ma non troppo

Manuel Mendes Gomes et al. BMJ Case Rep. .

Abstract

Q fever is a zoonosis caused by Coxiella burnetii. It often manifests as a flu-like syndrome; other common manifestations are pneumonia, hepatitis and endocarditis. Its course may be acute or chronic. The authors present two clinical cases of Q fever with rare manifestations. Case 1: A 55-year-old man admitted due to abdominal pain, diarrhoea and fever. Blood tests showed elevated transaminases, low platelets and elevated C reactive protein, with normal white cell counts; abdominal ultrasound showed splenic and hepatic abscesses. Serologies to C burnetii were positive (1:640), leading to the diagnosis of Q fever with splenic and hepatic abscesses. Case 2: A 47-year-old man admitted due to headache after sneezing, with unstable gait and vertigo. A brain tomography showed cerebral venous thrombosis. After an exhaustive investigation, antibodies to C burnetii were found and were undoubtedly positive (1:5120), leading to the diagnosis of Q fever. Both patients were treated with oral doxycycline.

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Figures

Figure 1
Figure 1
Case 1: chest X-ray, performed at the casualty department showing mild right pleural effusion.
Figure 2
Figure 2
Case 1: abdominal CT, performed at casualty department showing splenic infracentimetric hypodense nodules.
Figure 3
Figure 3
Case 1: abdominal CT, performed at casualty department showing splenic infracentimetric hypodense nodules.
Figure 4
Figure 4
Case 1: abdominal CT, performed at casualty department showing splenic infracentimetric hypodense nodules.
Figure 5
Figure 5
Case 1: control abdominal CT, performed during admission at internal medicine ward, 5 days after initiating doxycycline showing the absence of hepatic nodules and reduction of splenic masses.
Figure 6
Figure 6
Case 1: control abdominal CT, performed during admission at internal medicine ward, 5 days after initiating doxycycline showing the absence of hepatic nodules and reduction of splenic masses.
Figure 7
Figure 7
Case 1: control abdominal CT, performed during admission at internal medicine ward, 5 days after initiating doxycycline showing the absence of hepatic nodules and reduction of splenic masses.
Figure 8
Figure 8
Case 2: Brain CT performed at casualty department showing spontaneously hyperdense superior sagittal sinus and torcular filling defect.
Figure 9
Figure 9
Case 2: Brain CT venography performed at casualty department to confirm changes identified in brain CT showing venous thrombosis of left longitudinal sinus and transverse sinus.
Figure 10
Figure 10
Case 2: Brain CT venography performed at casualty department to confirm changes identified in brain CT showing venous thrombosis of left longitudinal sinus and transverse sinus.
Figure 11
Figure 11
Case 2: MRI venography (three-dimensional reconstruction images), performed 1 year after the event showing normal permeability of venous sinus.
Figure 12
Figure 12
Case 2: MRI venography (three-dimensional reconstruction images) performed 1 year after the event, showing normal permeability of venous sinus.
See this image and copyright information in PMC

References

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