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[Bone marrow granulomatosis in Q-fever]
G Rexroth1, W Rösch, M Altmannsberger
1Medizinische Klinik, Krankenhauses Nordwest der Stiftung Hospital zum Heiligen Geist, Frankfurt/M. Rexrothmed@aol.com
Medizinische Klinik (Munich, Germany : 1983)
|August 16, 2000
Summary
Diagnosing protracted Q-fever in a patient with prolonged fever of unknown origin (FUO) was achieved through bone marrow biopsy revealing fibrin ring granulomas. This highlights the diagnostic utility of bone marrow examination for FUO.
Area of Science:
- Infectious Diseases
- Hematology
- Internal Medicine
Background:
- Fever of Unknown Origin (FUO) is defined by persistent fever without a clear diagnosis after extensive investigation.
- Infectious etiologies account for approximately 25% of FUO cases, including abscesses, endocarditis, and tuberculosis.
- Protracted Q-fever can present as a challenging diagnostic dilemma within the FUO spectrum.
Observation:
- A 29-year-old patient presented with a 3-month history of undulating fever.
- Initial investigations for FUO were inconclusive.
- Bone marrow biopsy was performed to investigate the persistent fever.
Findings:
- The bone marrow biopsy revealed characteristic fibrin ring granulomas.
- These granulomas are a key diagnostic indicator for Q-fever.
- Elevated Coxiella burnetii antibody titers confirmed the diagnosis of Q-fever.
Implications:
- Bone marrow biopsy is a valuable diagnostic tool for evaluating FUO.
- Identifying specific histopathological findings like fibrin ring granulomas can lead to timely diagnosis of challenging infections.
- This case underscores the importance of considering less common infectious causes in FUO and utilizing invasive diagnostic procedures when necessary.