Coxiella burnetii Femoro-Popliteal Bypass Infection: A Case Report

Abstract

Cardiovascular infections are the most severe and potentially lethal among the persistent focalized Coxiella burnetii infections. While aortic infections on aneurysms or prostheses are well-known, with specific complications (risk of fatal rupture), new non-aortic vascular infections are increasingly being described thanks to the emerging use of 18-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET-scan). Here, we describe an infection of a femoro-popliteal bypass that would not have been diagnosed without the use of PET-scan. It is well-known that vascular prosthetic material is a site favorable for bacterial persistence, but the description of unusual anatomical sites, outside the heart or aorta, should raise the clinicians' awareness and generalize the indications for PET-scan, with careful inclusion of the upper and lower limbs (not included in PET-scan for cancer), particularly in the presence of vascular prostheses. Future studies will be needed to precisely determine their optimal management.

Keywords: Coxiella burnetii; PET-scan; Q fever; vascular graft infection.

Figure 1

PET-scan (16 November 2017) showing hypermetabolism of the left radius (A), left and right popliteal aneurysms (B), left femoropopliteal bypass (C), the aorta, bilateral inguinal adenopathies (D), shoulders (E), left pulmonary nodule, and mitral valve (F).