Q fever (Coxiella Burnetti): rare diagnosis on liver biopsy

Abstract

Case report A 39-year-old male presented with unexplained fever, hepatosplenomegaly, jaundice and encephalopathy. Liver biopsy was performed as a last diagnostic tool. Macroscopic examination showed 5–15 mm of multiple fragments of liver cores. Microscopically there was inflammatory infiltrate in both liver lobules and portal tracts composed primarily of histiocytic granulomas. The granulomas had a distinct ring form with central clearing and a ring of fibrin. Immunohistochemistry was positive for CD68 and negative for CMV, ZN and fite. Diagnosis Granulomatous hepatitis with ring granulomas (Q fever). Discussion Q fever, due to Coxiella burnetti is a ubiquitous zoonosis. In humans, infection results from inhalation of contaminated aerosols from amniotic fluid or placenta or contaminated wool. Diagnosis can be confirmed by serology and/or DNA amplification from blood, cerebrospinal fluid, bone marrow, bone biopsy, liver biopsy and fetal specimens. The immune response results in the formation of granulomatous lesions most commonly involving the lungs, liver, and bone marrow. Prognosis Q-fever present as acute or illness which can be treated by oral doxycycline.