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Introduction: Fever is a cosmopolit zoonosis due to Coxiella burnetii. The diagnosis of chronic Q fever can be really misleading. The growth of this bacterium is difficult and blood cultures are often negatives., Case Presentation: We rapport here the case of a 69-year-old man presenting with an alteration of his general condition and low back pain. He suffered from a well-controlled HIV infection and lower limb arteriopathy treated with a cross-femoral bypass. A computed tomography scan revealed a L3-L4 abscessed spondylodiscitis but multiple blood cultures remained sterile, and the transthoracic echocardiography was normal. PET scan showed a hypermetabolism on L3-L4 vertebrae but also indicated an intense uptake of the cross-femoral bypass. C. burnetii serology was in favour of a chronic Q fever. The management of this chronic Q fever needed a multidisciplinary discussion. Three months after the treatment initiation, C. burnetii serology was reduced by a titer and has stabilized 6months to a year., Conclusion: Chronic Q fever and mostly osteoarticular diseases are difficult to diagnose. We have to evoke the diagnosis of osteoarticular chronic Q fever in case of insidious inflammatory syndrome, negatives blood cultures spondylodiscitis especially when associated to endocarditis or vascular infection, and in case of spondylodiscitis with a granulomatous histology without Mycobacterium tuberculosis. Although there are many complementary tests (PET scanner, PCR), serology remains the cornerstone of diagnosis., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

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., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Q fever is a zoonosis caused by Coxiella burnetii with a presentation ranging from asymptomatic seroconversion to possibly fatal chronic Q fever. The Netherlands faced an exceptionally large outbreak of Q fever from 2007 to 2010: 4026 human cases were notified, which makes it the largest Q fever outbreak ever reported. This outbreak, because of its size, allowed collecting a wide range of information on the natural history of Q fever, as well as on its transmission and clinical presentation. It also posed unprecedented public healthcare problems, especially for the concomitant management of the epizootic by veterinarian authorities and public health authorities, but also for the management of transmission risk related to blood donation. The need for cost efficient measures emerged rapidly because of the great number of infected individuals or at risk of infection, with a need for guidance on follow-up of acute Q fever patients, screening of pregnant women, or implementation of diagnostic algorithms. The acute outbreak was controlled by drastic veterinarian measures but chronic Q fever will remain a problem for the coming years., (Copyright © 2014. Published by Elsevier SAS.)