NECROTIZING BRONCHITIS, ANGIITIS, AND AMYLOIDOSIS ASSOCIATED WITH CHRONIC Q-FEVER

The authors report the clinical, radiological and histological finding s in a 63-year-old male patient who developed severe necrotizing bronc hitis, necrotizing angiitis, and secondary amyloidosis of the right up per love and intermediate bronchus. The patient expired due to respira tory insufficiency. At the age of 27 years, the patient had had radiot herapy of the mediastinum because of suspected Hodgkin's disease. Acut e pneumonia suggestive of Q-fever infection was diagnosed at the age o f 48. Progressive restrictive lung disease developed during the last d ecade. Serological evaluation revealed IgM and IgA high titers against Coxiella burnetii. IgA, complement and amyloid deposits were detected in the walls of small arteries. Bronchial lavage and pleural effusion s displayed numerous activated T lymphocytes. Analysis of endogenous l ectins revealed alterations of the pulmonary defense system. The clini cal history, histological and immunological findings suggest that chro nic Q fever may induce remarkable changes in the immune system, compar able to autoimmune-reactive diseases.