Q fever pneumonia

Case contributed by Dr Yair Glick

Presentation

Fever, dry cough.

Patient Data

Age: 35 years
Gender: Male
X-ray

Oval opacity with air bronchogram in RUL - most probably pneumonia, although a mass cannot be confidently ruled out.

CT

Perihilar consolidation in RUL with air bronchogram and ground glass halo.
Mild right hilar adenopathy.

5-mm nodule in RLL.

Diffuse smooth bronchial wall thickening, probably smoking-related.

Chest XR 5 days after CT

X-ray

Follow-up X ray shows partial resolution of the RUL infiltrate.

Case Discussion

Fever, dry cough, diarrhea and dysuria for past 2 days in a smoker. Temperature of 37.7 C at the ER, coarse ronchi over right lung, no leukocytosis but elevated CRP.

Oval infiltrate in RUL on chest X ray and CT. Recent history of treated dentoalveolar abscess 2 months earlier. Started on ceftriaxone and metronidazole, taking into account poor dental hygiene.

Echocardiogram negative for heart valve vegetations, blood cultures were sterile and the radiographic studies did not show septic emboli. High index of suspicion for atypical pneumonia - serology sent for Bartonella, Chlamydia, HIV, and Coxiella and the patient was started on doxycycline. Serology for Q fever came back positive.

A chest X ray taken 5 days after the CT study showed partial resolution of the infiltrate.

Retrospectively, the patient reported exposure to cats and a crow.

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