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Title: Slepende koorts en asthenie bij een 42-jarige garagist
Author(s): ANNAERT M, VERBEKE G, D’HEYGERE F, PEETERMANS WE
Journal: Tijdschrift voor Geneeskunde
Volume: 60    Issue: 22   Date: 2004   
Pages: 1613-1618
DOI: 10.2143/TVG.60.22.5002030

Abstract :
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Persistent fever and asthenia in a 42-year-old garagist
We report a case of a male patient presenting with persistent fever, asthenia, non-purulent cough and loss of weight. Clinical examination and radiology did not reveal abnormalities. Serum analysis revealed pancytopenia, raised CRP, sedimentation rate and liver enzymes. A PET-scan was normal. Bone marrow biopsy showed the presence of granulomas.
Extensive testing of the serology proved positive for Coxiella burnetii. Q fever is an ubiquitous zoonosis with a large reservoir. The disease may be acquired by the respiratory or digestive route after contact with parturient sheep or cattle. Going over the medical history again – after diagnosis – revealed that this patient indeed had been in contact with parturient sheep.
The incidence of Q fever is unknown and may be underestimated. The clinical presentation of Q fever is polymorphic and nonspecific; it may be acute, most often as a pneumonia or hepatitis, or chronic, most often as an endocarditis. Inapparent and subclinical infections are common. The diagnosis of Q fever relies mainly upon serology, the most commonly used method being the immunofluorescence assay. Serological testing for Q fever should always be done for a patient with prolonged fever, granulomatous lesions in the liver or bone marrow, and culture-negative endocarditis.
This case illustrates the importance of a meticulous history taking, and the usefulness of a bone marrow biopsy in patients with prolonged fever. Our patient was successfully treated with tetracyclines.

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