[Hepatic granulomatosis caused by Q fever: a cause of erroneous tuberculosis diagnosis]

We present the case of a 31-year-old man hospitalized for the study of a fever syndrome. The patient developed acute respiratory failure, with anemia and hepatic affection. In the histological examination of the liver and bone marrow, the presence of granulomas suggesting a tuberculous etiology was demonstrated. Antibodies IgG anti-Coxiella burnetti were detected, using indirect immunofluorescence, at the level of 1/200, with latter seroconversion to 1/800. Therapy with doxycycline was administered (200 mg/day during 14 days). Fever subsided in 24 hours and the other clinico-biochemical disorders disappeared in the following days. After the literature review, we conclude that Q fever must be taken into account for the differential diagnosis of any granulomatous disease observed in the liver and/or bone marrow. We can confirm that any granuloma is specific of just one pathological entity. The diagnosis must be always supported by other clinical, supplementary and serological data.