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The Development of Lyophilized Loop-mediated Isothermal Amplification Reagents for the Detection of Coxiella burnetii
Published on: April 18, 2016
Acute Q fever revealed by an anti-phospholipid syndrome: A case report
K Balasoupramanien1, J-B Roseau2, N Cazes3
1173rd Medical Unit, 11th Army Medical Centre, 10, rue Roquemaurel, 31032 Toulouse, France.
Introduction:
Q fever is a zoonosis caused by Coxiella burnetii. Acute infection is mainly asymptomatic. In other cases it mainly causes a flu-like illness, a pneumonia, or an hepatitis. We present an atypical case of an acute Q fever revealed by a massive pleural effusion.
Case Report:
We report the case of a 43-year-old man referred to our hospital for an acute respiratory distress. Further analyses showed an exudative eosinophilic pleural effusion, associated with a pulmonary embolism and a deep femoral vein thrombosis. Aetiologic explorations revealed an acute Q fever (IgM and IgG against C. burnetii phase II antigens) associated with anti-phospholipids. The outcome was favorable with vitamin K antagonists, doxycycline, and hydroxychloroquine, till the negativation of the anti-phospholipid antibodies.
Discussion And Conclusion:
During acute C. burnetii infections, anti-phospholipid antibodies are highly prevalent but thrombotic complications are rare. The 2023 ACR/EULAR APS criteria restricts the diagnosis of APS, as in our case of acute severe infection. In front of an atypical pneumonia and/or thrombotic events, screening of C. burnetii and anti-phospholipid antibodies could be useful. Given its low level of evidence, prolongated treatment by doxycycline, hydroxychloroquine ± anticoagulant for C. burnetii's associated anti-phospholipid syndrome is discussed, but succeeded in our case.
Insights
This case study highlights an unusual presentation of Q fever (Coxiella burnetii infection) revealed by significant pleural effusion and thrombosis. Early screening for Coxiella burnetii and antiphospholipid antibodies is recommended for atypical pneumonia with thrombotic events.
Area of Science:
- Infectious Diseases
- Rheumatology
- Pulmonology
Background:
- Q fever, a zoonosis caused by Coxiella burnetii, typically presents asymptomatically or with flu-like symptoms, pneumonia, or hepatitis.
- Atypical presentations, such as massive pleural effusion, are uncommon but possible during acute C. burnetii infections.
Observation:
- A 43-year-old male presented with acute respiratory distress, diagnosed with exudative eosinophilic pleural effusion, pulmonary embolism, and deep femoral vein thrombosis.
- Etiologic investigations confirmed acute Q fever and the presence of antiphospholipid antibodies.
Findings:
- Acute Q fever infection was identified through serological testing for Coxiella burnetii phase II antigens.
- The patient's condition improved with a treatment regimen including vitamin K antagonists, doxycycline, and hydroxychloroquine, leading to the negativation of antiphospholipid antibodies.
Implications:
- Antiphospholipid antibodies are prevalent in acute C. burnetii infections, though thrombotic complications are rare.
- Screening for C. burnetii and antiphospholipid antibodies is valuable in cases of atypical pneumonia and/or thrombotic events.
- The management of C. burnetii-associated antiphospholipid syndrome requires further research, but a combination of doxycycline, hydroxychloroquine, and anticoagulation proved effective in this case.
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