Korean J Gastroenterol.  2011 Mar;57(3):189-193. 10.4166/kjg.2011.57.3.189.

Q Fever as a Cause of Acute Hepatitis Accompanying Fever

• Lee HJ
• Kim JH
• Yoon EL
• Lee YS
• Yeon JE
• Byun KS
• Kim BH
• Ryu Y

• KMID: 1128359
• DOI: http://doi.org/10.4166/kjg.2011.57.3.189

Abstract

Q fever is a zoonotic infection caused by Coxiella burnetti, which has been previously regarded as an uncommon infectious disease in Korea but is sporadically reported recently. Common manifestations of acute Q fever usually present as influenza-like illness, pneumonia and occasionally hepatitis. Herein, we report 4 cases of acute Q fever as a cause of acute hepatitis and fever. All patients had fever and non-specific symptoms, and laboratory test showed acute hepatitis. Antibody surveys for many virus infections and bacterial cultures were negative. Finally, they were diagnosed acute Q fever by an indirect microimmunofluorescence test. Liver biopsy in 3 patients revealed granuloma including one with typical fibrin-ring. All patients had complete resolution of symptoms and signs with doxycycline treatment. Q fever should be considered in the differential diagnosis of patients with fever of unknown origin with acute hepatitis in Korea.

Keyword

Q fever; Coxiella burnetti; Hepatitis; Granuloma

MeSH Terms

Acute Disease
Adult
Anti-Bacterial Agents/therapeutic use
Coxiella burnetii/isolation & purification
Doxycycline/therapeutic use
Fluorescent Antibody Technique, Indirect
Hepatitis/*diagnosis/etiology/pathology
Humans
Male
Middle Aged
Q Fever/complications/diagnosis/drug therapy
Rifampin/therapeutic use

Figure

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  Fig. 1. A liver biosy specimen of case 1 (H&E stain, ×400). A lipid granuloma with a fibrinoid ring (arrow) within the inflammatory focus, and small vague granuloma were noted.

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  Fig. 2. A liver biosy specimen of case 2 (H&E stain, ×400). A granuloma composed of mixture of elongated epithelioid cells, histiocytes, and lymphocytes were noted.

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