Q Fever masquerading as prostate cancer metastases

Area of Science:

• Nuclear Medicine
• Oncology
• Infectious Diseases

Background:

• A 66-year-old man with newly diagnosed prostate cancer presented with bone and abdominal pain.
• Initial imaging suggested prostate cancer metastases, prompting further investigation.

Observation:

• Bone scan revealed suspicious lesions for metastases.
• FDG PET/CT showed FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy.
• Biopsies revealed noncaseating granulomas, ruling out malignancy.

Findings:

• Extensive serologic evaluation confirmed elevated Q fever titers.
• The patient was diagnosed with Q fever.

Implications:

• This case underscores the diagnostic challenge of differentiating Q fever from prostate cancer metastases using imaging.
• It emphasizes the need for comprehensive clinical and serologic evaluation when imaging findings are atypical for the suspected diagnosis.
• Nuclear medicine and PET/CT imaging findings in Q fever can mimic neoplastic processes.