Sheep, chills and doughnut granulomas - atypical course of a coxiella sepsis

Q fever usually presents with high fever. headache and an atypical pneumoni a. A case report of a 47-year-old patient with an atypical course of a coxi ella infection is described. The dominant clinical symptoms were a liver an d lune marrow involvement whereas pulmonary manifestations were absent. The diagnosis of Q fever in this patient was based on the detection of cytopla smatic inclusion bodies in macrophages and granulocytes. Furthermore fibrin -ring ganulomas (>>doughnut lesions<<) were found in liver tissue specimen and epitheloid-cell granulomas were detected in bone marrow specimen. Compl ement-fixation antibody titers and PCR resulted unspecific or negative on d ifferent occasions during the course of the disease. A confirmation of the diagnosis by complement-fixation antibody; test was possible only after rec overy from the disease. In Q fevor with atypical clinical and serological presentation the screenin g of blood tells for inclusion bodies and liver or bone marrow tissue for g ranulomas may be important for establishing the diagnosis.